tag:blogger.com,1999:blog-28102664528514943012014-10-14T05:03:44.011-07:00Incision and Drainage<a href="http://organizedwisdom.com/Dustin-Ballard-MD/dballard30/pxno/med"><img src="http://organizedwisdom.com/skins/orgwis2/images/profilebadge_expert_health.png" border="0"></a>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comBlogger104125tag:blogger.com,1999:blog-2810266452851494301.post-44488359127120701472013-01-01T09:03:00.000-08:002013-01-01T09:03:02.921-08:00Holiday Heart (Marin IJ) <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>496</o:Words> <o:Characters>2829</o:Characters> <o:Company>Angela Ballard Writing</o:Company> <o:Lines>23</o:Lines> <o:Paragraphs>5</o:Paragraphs> <o:CharactersWithSpaces>3474</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings></xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument></xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles></xml><![endif]--> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style><![endif]--> <!--StartFragment--> <br /><div class="MsoNormal"><span style="font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 11.0pt; mso-hansi-theme-font: major-latin;">Twas the day after Thanksgiving, and all through the house, not a creature was stirring, not even an over-sized spouse. The empty bottles lay strewn all around without care, a sure sign that black out Friday was already there. When inside your chest there arose such a clatter, an odd pounding of the heart, which seemed to mean something was definitely the matter. Up from bed you flew in a flash, and off to the cabinet for the aspirin stash. <span style="mso-spacerun: yes;">&nbsp;</span>And then, with a palpitation, you recall what’d your heard, of an irregularly irregular heartbeat louder than a large bird. The answer buzzed in your head and turned you around, in your chest a case of ‘holiday heart’ had surely been found. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 11.0pt; mso-hansi-theme-font: major-latin;">To the phone you went, moving none to quick, as you knew in that moment that you must phone Doctor Tick. More rapid than hummingbirds, his answers they came. And he whistled, and sniffled, and called the possible rhythms by name!<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 11.0pt; mso-hansi-theme-font: major-latin;">“Could be Afib! Or Flutter, or rapid rate due to Hyperthyroidism! Could be PVC or SVT, or much less likely something secondary to pulmonary embolism! But the cause of the problem, yes the cause of it all, is most certainly, yes most certainly, your excessive intake of alcohol.”<o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 11.0pt; mso-hansi-theme-font: major-latin;">After this information settled and you’d stifled a cry, you took a deep breath, and asked Doctor Tick…Why? So ear to phone, you listened as his answer it flew. Not too sure, he said, could be changes in body stress hormones, or effects of fatty acids too. <span style="background: white; mso-bidi-font-weight: bold;"><br /><br /></span>And then, in a twinkling, you heard his voice, reciting epidemiology, and you had no choice.<span style="mso-spacerun: yes;">&nbsp; </span>Atrial fibrillation, that is Afib, he said, is the most common by far. That common rhythm caused by an irregular atria, is often picked up at a bar! The numbers in studies jump all around, but up to a 35% linkage of new Afib and alcohol use has been found. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 11.0pt; mso-hansi-theme-font: major-latin;">So there it was, the diagnosis as clear as day, and now all that was left was to ask Doctor Tick how you could make it go away. It may pass, he said, it may pass real soon, but I’m afraid my friend that you must listen to my cautionary tune. <o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 11.0pt; mso-hansi-theme-font: major-latin;">“Now fluids, now rest, now abstention and healthy meal-fixing. On aspirin, on pulse monitoring, on moderation and no cocktail-mixing. To the ER you should go if your chest feels tight. Or if you have difficulty breathing, dizziness or your palpitations last all through the night! And recall my friend, that your body handles holiday stress when it is at its best: exercise, eat well, and get plenty of rest.<span style="background: white; mso-bidi-font-weight: bold;"><br style="mso-special-character: line-break;" /><!--[if !supportLineBreakNewLine]--><br style="mso-special-character: line-break;" /><!--[endif]--></span><o:p></o:p></span></div><div class="MsoNormal"><span style="font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 11.0pt; mso-hansi-theme-font: major-latin;">And as he was speaking, as quick as whistle, away the flutters flew like the down of a thistle. And I heard Dr. Tick say, in my head ‘ere that night. Happy Holidays to all but for alcohol and holiday heart, let’s say good night!<o:p></o:p></span></div><div class="MsoNormal"><span style="background: white; font-family: Cambria; font-size: 14.0pt; line-height: 115%; mso-ascii-theme-font: major-latin; mso-bidi-font-size: 12.0pt; mso-bidi-font-weight: bold; mso-hansi-theme-font: major-latin;"><br /><u>Author’s notes</u>; First, a hearty thanks to Clement Moore for setting the metronome for this column. Second, holiday heart refers to a diverse population of heart arrhythmias – some benign and some more sinister.<span style="mso-spacerun: yes;">&nbsp; </span>The most common of these is atrial fibrillation – a widespread arrhythmia that has many possible causes and triggers, of which alcohol is just one. Among the other causes; abnormalities with the arteries or valves of the heart, acute infections, disruption of hormonal mechanisms like the thyroid, and, as we learned recently, coaching an NFL franchise. Thus, those suffering from an irregular heartbeat, especially one associated with chest pain or shortness of breath, should not wait long before consulting a physician. <span style="mso-spacerun: yes;">&nbsp;</span><o:p></o:p></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><!--EndFragment-->DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-32015993354720940122012-10-20T09:05:00.004-07:002012-10-20T09:05:37.432-07:00Brain Freeeeeeeze (Marin IJ)<span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><br /></span> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>607</o:Words> <o:Characters>3462</o:Characters> <o:Company>Angela Ballard Writing</o:Company> <o:Lines>28</o:Lines> <o:Paragraphs>6</o:Paragraphs> <o:CharactersWithSpaces>4251</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings></xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument></xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles></xml><![endif]--> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;} </style><![endif]--> <!--StartFragment--> <br /><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">It’s popsicle-o-clock at the Ballard house and everyone is content… until a horrible shriek reverberates through the home. The perpetrator is three-year-old Holden and his tribal yell quickly morphs into a plaintative wail of “brain freeeeeeeeezzzzze.” In a moment, the pain (for all of us) recedes and our daughter, removing her hands from her ears, asks, “Dad, what causes ‘brain freeze?’” Until recently I would have answered: “Popsicles.” But now, thanks to new evidence, I can instead tell her, “vasodilatation of the anterior cerebral artery.”<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">This past April, Jorge Serrador of Harvard Medical School and colleagues reported the results of a small study suggesting an explanation for the bodily processes (physiology) involved with brain freeze (known in medicalese as <i style="mso-bidi-font-style: normal;">sphenopalatine ganglioneuralgia</i>.) Now, I know what you might be thinking – with autism unexplained and cancer uncured, aren’t there greater priorities for medical research than a painful yet benign experience like <i style="mso-bidi-font-style: normal;">sphenopalatine ganglioneuralgia</i>? And, you would be absolutely right. However, there is a bit more to it, and some have long posited that the physiology of brain freeze might be related to that of other (less temporary) conditions – such as post-traumatic and migraine headaches. In fact, prior studies have suggested that migraine sufferers are more likely than other folks to experience brain freeze. So, with that in mind, let’s get back to the research at hand. <o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;">Serrador and colleagues recruited thirteen healthy adults willing to suffer through brain freeze in the name of science (and I’m guessing there were other inducements as well). While researchers monitored the blood flow in their brains with transcranial Doppler (ultrasound), the volunteers sipped ice water through straws pressed against their upper palates. Then, they raised their hands to signal the freeze and thaw of brain freeze. Brain blood flow under these conditions was then compared with that of the same volunteers sipping warm water. The results of the study were presented at the Experimental Biology 2012 conference in San Diego and were notable in that the researchers observed that one particular artery, the anterior cerebral artery, dilated rapidly and flooded the brain with blood in conjunction with the freeze sensation. Soon after this vasodilatation occurred, the same vessel constricted (tightened) as the volunteers' pain receded. Now, remember, this was a small study and it’s results have yet to complete the rigorous peer review process associated with manuscript publication. Nonetheless, there do seem to be some important implications in these findings. </span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><br /></div><div style="margin-bottom: .1pt; margin-left: .5in; margin-right: 0in; margin-top: .1pt; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span style="mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">1)<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;">Migraine headaches</b>. These are thought to be caused by abnormal dilation of arteries in the brain, and many existing treatments attempt to modulate this process. These results then, support this concept and may lead to greater focus on migraine treatments that prevent dilation in the first place. And, for people with friends or family members with migraines, this study provides us with a way to relate to their pain. For some with migraines, the headache must certainly feel like one long brain freeze. Ouch.</span></div><div style="margin-bottom: .1pt; margin-left: .5in; margin-right: 0in; margin-top: .1pt;"><br /></div><div style="margin-bottom: .1pt; margin-left: .5in; margin-right: 0in; margin-top: .1pt; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span style="mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">2)<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;">The suddenness of sensation matters</b>. We’ve all heard about the frog that will jump out of a pot of boiling water but will stay in a tub slowly brought from ambient temperature to a boil. One of the aspects of brain freeze that makes it so uncomfortable is the rapidity and severity of its onset. This principle is worth keeping in mind for other situations. Take, for example, removing a bandage. The conventional wisdom is that pulling it off quickly is better, as it gets the pain over and done with. But some researchers, such as Dan Ariely, the author of the fascinating book <i style="mso-bidi-font-style: normal;">Predictably Irrational, </i>contend the opposite; the quicker the pain the more severe the pain, and thus the greater the overall discomfort. So perhaps very slowly removing a band-aid is actually more comfortable than yanking it right on off. That’s a topic to be exposed more thoroughly some other time.</span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><br /></div><div style="margin-bottom: .1pt; margin-left: .5in; margin-right: 0in; margin-top: .1pt; mso-list: l0 level1 lfo1; text-indent: -.25in;"><!--[if !supportLists]--><span class="Apple-style-span" style="font-family: Times, 'Times New Roman', serif;"><span style="mso-bidi-font-family: Times; mso-fareast-font-family: Times;"><span style="mso-list: Ignore;">3)<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><!--[endif]--><b style="mso-bidi-font-weight: normal;">Now,</b>I can turn Holden’s occasional freezathon into a spelling lesson for his sister. Ok, here we go, let’s try “<i style="mso-bidi-font-style: normal;">sphenopalatine ganglioneuralgia.” S...P...H…</i></span></div><!--EndFragment-->DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-13966176028623972932012-10-20T09:02:00.000-07:002012-10-20T09:07:00.639-07:00On Breast Cancer Risk (Marin IJ)<br /><br /><!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>852</o:Words> <o:Characters>4858</o:Characters> <o:Company>Angela Ballard Writing</o:Company> <o:Lines>40</o:Lines> <o:Paragraphs>9</o:Paragraphs> <o:CharactersWithSpaces>5965</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings></xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument></xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles></xml><![endif]--> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;} </style><![endif]--> <!--StartFragment--> <br /><div class="MsoNormal">Establishing cause and effect is one of the trickiest aspects of medicine. So-called “causality” can be elusive, especially once you move beyond connect-the-dots type circumstances (exhibit A; Mom cuts finger with bagel knife = bleeding Mom.) </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Here in Marin, we worry and wonder a lot about breast cancer. Why does a particular woman get breast cancer? How does another woman avoid it? These are difficult and often unanswerable questions. Unlike the knife and finger example, there are a litany of possible reasons why an individual might develop breast cancer. And, even if we expand the question to what increases the risk of breast cancer across a broad population, satisfactory answers are slippery. It is with this in mind that we should view the recent evidence regarding breast cancer in Marin County. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">It is well documented that Marin has historically had an abnormally high rate of new breast cancer cases. In particular, data from the late 1990s demonstrate breast cancer rates some 15% higher than those found across the rest of the state. Multiple culprits – lifestyle, hormones, toxins, and genetics – have been proposed and studied, without the emergence of a single smoking gun. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">A study recently published in the <i style="mso-bidi-font-style: normal;">Journal of the American College of Surgeons</i> has proposed yet another possible cause – genetic differences in Vitamin D receptors. The study, conducted by Dalessandri and colleagues, examined the DNA of 164 Caucasian women living in Marin and diagnosed with breast cancer between 1997-1999. They compared their genetic profiles with those of 174 breast-cancer-free matched controls and found that women at statistically high risk for breast cancer were 1.9 times more likely to have a specific difference (called a variant) in the gene which dictates how the body utilizes Vitamin D (the Vitamin D receptor). Vitamin D has received quite a bit of attention for its possible benefit in deterring certain types of cancers and animal models have demonstrated that it has a beneficial effect on breast cancer tumor growth. Thus, differences in how Vitamin D is processed by its receptors is a logical explanation for why certain women (in Marin and elsewhere) would be at higher risk for developing cancer. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">But before you march out to determine your Vitamin D receptor profile, let’s put these findings in proper prospective. First of all, this was a small “pilot” study and should be considered preliminary evidence. Medical practice and investigation is ripe with prominent associations that have not borne out in larger studies; oat bran and heart disease, and (who can forget?) vaccines and autism, and on and on. In fact, there are more disproven associations in medicine than proven ones. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">A much larger study of Marin Women (the “Marin Women’s Study” www.marinwomensstudy.org) with 14,000 participants is ongoing and analysis of their DNA samples (there are some 8500 available) should provide more robust data on Vitamin D receptor variants and genetic risk. Furthermore, the genetic data from Dalessandri’s study is from fifteen years ago – during a time when breast cancer rates were peaking – especially in Marin. While multi-factorial, we know that this peak was due, in part, to combined post-menopausal hormone (estrogen and progesterone) therapy – a known risk factor for developing breast cancer, and a treatment more common (at the time) in Marin than elsewhere in California. Thus, we must be careful to extrapolate the findings regarding breast cancer risk from a prior generation to today’s milieu. Finally, one must always be particularly fastidious when reviewing the results of studies that focus on a specific proprietary drug (remember Vioxx?) or test. While this study was funded by state, county and charitable sources, the results quite prominently affect the fortunes of genetic testing company InterGenetics Incorporated, which is marketing OncoVue® - a “genetic-base, breast cancer risk test.”<span style="mso-spacerun: yes;">&nbsp; </span>Thus, while interactions between genes and the environment is certainly a promising field, the jury on Vitamin-D receptors and breast cancer is most definitely still out. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Where then, does this leave us with breast cancer causality? Well remember, this is tricky – proving a clear-cut link between a dietary item, personal habit, or medical treatment and a disease process is fraught with the potential for mis-interpretation. Nonetheless, there are certainly some risk factors that we can confidently delineate. Some genetic risk is clearly proven – and a family history of breast cancer is a known red flag – especially if due to a known BRCA mutation. In terms of risky environmental exposures, an <i style="mso-bidi-font-style: normal;">Institute of Medicine</i> committee report released last year summarizes these quiet nicely as “hormone therapy that combines estrogen and progestin, exposure to ionizing radiation…excess weight among post-menopausal women and alcohol consumption.” Other environmental agents – chemicals such as bisphenol A (BPA) – have been implicated and are biologically plausible but at this time unproven. Mary Mockus, a surgeon at Kaiser-Permanente San Rafael and a member of the collaborative Marin Women’s Study team, thinks that the ‘toxic soup’ present in higher socioeconomic areas like Marin County is likely to play some role in the higher breast cancer rates, but that we are unlikely to ever identify one clear cut perpetrator. And, this then, fits quite well with what we know about causality in medicine. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Thus for Marin women, the best advice for preventing breast cancer is probably the best advice for preventing m<a href="http://www.blogger.com/blogger.g?blogID=2810266452851494301" name="_GoBack"></a>any diseases; sleep well, get regular exercise, know your family’s medical history and discuss individualized screening plans with your doctor…don’t smoke, avoid excesses of alcohol, drugs and ionizing radiation, and eat plenty of green leafy vegetables. And a healthy Vitamin D level (ask your doctor!) won’t hurt either.&nbsp;</div><!--EndFragment-->DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-55051329301213696492012-10-20T08:56:00.001-07:002012-10-20T08:56:25.315-07:00Cannabinoid Hyperemesis (Marin IJ) <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>644</o:Words> <o:Characters>3675</o:Characters> <o:Company>Angela Ballard Writing</o:Company> <o:Lines>30</o:Lines> <o:Paragraphs>7</o:Paragraphs> <o:CharactersWithSpaces>4513</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings></xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> <w:UseFELayout/> </w:Compatibility> </w:WordDocument></xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles></xml><![endif]--> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; line-height:115%; mso-pagination:widow-orphan; font-size:11.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Calibri; mso-ascii-theme-font:minor-latin; mso-hansi-font-family:Calibri; mso-hansi-theme-font:minor-latin;} </style><![endif]--> <!--StartFragment--> <br /><div class="MsoNormal">Every once in a while in medicine a new discovery comes along that, on its face, seems to make no sense at all. What if I were to tell you that a popular drug – one that’s been sampled by two out of every five Americans and is renowned for its relaxation and anti-nausea properties – could actually cause severe bouts of nausea and vomiting among long-term users? These symptoms are worse in the morning and seem to be most effectively relieved by a long hot shower. Hmmm, smells a bit skunky, right? But, recently published reports seem to confirm the phenomenon. And, you might be more than a bit surprised by the culprit: THC. <span style="mso-spacerun: yes;">&nbsp;</span></div><div class="MsoNormal"><span style="mso-spacerun: yes;"><br /></span></div><div class="MsoNormal">Cannabinoid hyperemesis (THC associated vomiting) was first described in 2004 but remains a relatively unknown and underappreciated malady. A recent case series by Douglas A. Simonetto and colleagues at the Mayo Clinic in Rochester, MN, compiled data on 98 patients with this condition – and in the process they’ve put it on the map as a medical diagnosis. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">The accumulating evidence about cannabinoid hyperemesis gives us this typical patient profile: a chronic cannabis user under the age of 50 who develops periodic and severe abdominal pain associated with nausea and vo<a href="" name="_GoBack"></a>miting that tends to be worse in the morning and to improve with hot showers or baths. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">For example, in Simonetto’s report (published in February 2012 in <i style="mso-bidi-font-style: normal;">Mayo Clinic Proceedings</i>), the study team reviewed 1,571 charts of patients seen at their institution between 2005 and 2010 and identified 98 that met their criteria for cannabinoid hyperemesis (long term cannabis users with recurrent vomiting not explained by any other medical illness). Of these, each one was under the age of 50 and the vast majority (95% of those for whom data was available) used cannabis at least twice a week. Of the 57 patients for whom the effect of hot water immersion was documented, 51 (91%) reported relief. Most patients (86%) also reported abdominal pain. From these results, the authors have proposed specific criteria for the diagnosis of cannabinoid hyperemesis – including most of the above characteristics. As to the cause of the paradoxical vomiting due to cannabinoids, several theories have been proposed, including the inhibitory effects of cannabis on peristalsis (the wave-like impulses that propel food through the intestines). It may also be that chronic use changes the effects of cannabinoids on THC receptors in the brain. More investigation is needed, however, and as of now we can only speculate as to why hot showers are such an effective treatment (it could be because hot water draws blood supply away from the gut and to the skin). Despite the uncertainty, this new evidence does have a couple important implications for how we think about cannabinoids.</div><div class="MsoNormal"><br /></div><div class="MsoListParagraphCxSpFirst" style="mso-list: l0 level1 lfo1; text-indent: -.25in;"><span style="mso-bidi-font-family: Calibri; mso-bidi-theme-font: minor-latin; mso-fareast-font-family: Calibri; mso-fareast-theme-font: minor-latin;"><span style="mso-list: Ignore;"><span style="font: 7.0pt &quot;Times New Roman&quot;;"><span class="Apple-style-span" style="font-family: Times; font-size: small;">&nbsp; &nbsp; &nbsp; 1)&nbsp;</span> &nbsp;</span></span></span><!--[endif]-->Today’s cannabis is not the same as your father’s puff the magic dragon. In particular, synthetic and oral cannabinoids can lead to much higher and prolonged exposure to THC or similar compounds – and this would, presumably, increase the risk of cannabinoid hyperemesis syndrome. In particular, “herbal incense” products like Spice and K2 can cause effects – including prolonged psychosis – that were rarely observed from marijuana alone in the era of dirt grass and flower power. Thus, while the evidence is accumulating that cannabinoids may be helpful in the treatment of a number of uncomfortable medical conditions – including those that cause nausea and vomiting! – one must be careful with the amount and delivery of the drug. Like any drug, cannabis is not risk- or side effect- free. </div><div class="MsoListParagraphCxSpLast"><br /></div><div class="MsoListParagraphCxSpLast">2) &nbsp;If you are a long-term cannabis user suffering from severe bouts of nausea and vomiting, there may be simple treatments. First, try a nice, long, hot shower. (I fear I may be setting myself up for public stoning here, but this may help explain why, for years, Fairfax’s medical marijuana clinic was located right next to a Frogs Hot Tubs). But I digress…<span style="mso-spacerun: yes;">&nbsp; </span>the second (and medically advised) treatment for cannabinoid hyperemesis is to stop using cannabis. In Simonetto’s case series, of those reporting have quit cannabis, six out of seven (86%) had complete resolution of symptoms.</div><div class="MsoListParagraphCxSpLast"><br /></div><div class="MsoNormal">In medicine, like in life, it is always good to constantly question and challenge assumptions. The long-standing assumption about cannabis is that it’s main danger is as a “gateway” drug – and that it is otherwise quite safe and side effect free. We are starting to learn that this is not exactly true. <span style="mso-spacerun: yes;">&nbsp;</span></div><!--EndFragment-->DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-15039845266306740562012-08-20T13:22:00.002-07:002012-10-20T08:52:38.344-07:00The Stick of the Issue (Marin IJ)<br /><br /><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">A Kiwi grade-schooler amazed his classmates with a remarkable feat of attraction. He suspended a spoon from his navel, held, as if floating, by an invisible attachment. An American preteen was the envy of her BFFs because she had a tongue bolt – achieved without the pain of piercing. How did they do it? Gorilla strength glue? Superhuman powers? Neither, actually, but rather a stalwart force present all around us but <i style="mso-bidi-font-style: normal;">not usually </i>within us. Fans of AMC’s <i style="mso-bidi-font-style: normal;">Breaking Bad</i> will recognize this force as the same one that Walter White used to destroy the evidence police had linking him to methamphetamine production. More mundanely, most of us will recognize it as the molecular reaction that secures photos and to-do lists to our refrigerators. Magnetism. And although magnets are part of our daily lives, they are not always harmless – in fact can exert very powerful and destructive forces on the human body. You may not have heard about it yet, but around the globe there’s a mini magnet problem. Here in the U.S., you might even call it an epidemic, with reports of magnet ingestions in children ages 0 to 17 having increased by approximately tenfold over the last ten years and resulted in hundreds of injuries and at least one known death. <span style="mso-spacerun: yes;">&nbsp;</span><o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">How can swallowing a magnet be worse than swallowing a marble or a bead? The stick of the issue has to do the remarkable force with which some magnets are attracted to one another – a force that can cause a lot of damage to gastrointestinal tissue when magnets travel through the gut to reunite with one another. Recently, a clinical report in the <i style="mso-bidi-font-style: normal;">Lancet </i>described two children (one aged 18 months and the other 8 years) with toy magnet ingestions. Both kids required surgeries <span style="mso-spacerun: yes;">&nbsp;</span>- one for significant intestinal injuries caused by the magnets’ compressive “pull” forces <span style="mso-spacerun: yes;">&nbsp;</span>– which can be up to 1300 Gauss (by comparison, a typical refrigerator magnet exerts only 50 Gauss) – against the bowel wall.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">A few months ago, the case of a ten-year old girl who ingested two toy magnets she had used to make her own “tongue piercing” received national news attention. While she avoided the pain of a real tongue piercing, she ended up short her appendix in the process. In Portland this past March, a three-year-old nearly died after swallowing 37 magnets. Inside her abdomen, the balls snapped together to form a ring – and </span><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 12.0pt; mso-hansi-theme-font: minor-latin;">tore at least four holes in her gastrointestinal tract. <span style="mso-spacerun: yes;">&nbsp;</span></span><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">In these instances, the common and concerning characteristic was the ingestion of multiple neodymium (“rare earth”) magnets. These neodymium magnets are a relatively new product – they were invented by General Motors in 1982 – and are five to ten times more powerful than traditional magnets. Still, solitary magnets, even of the neodymium variety, tend to pass through the gut without major incident. But multiple magnets, or magnets paired with other metal objects in the gut, pose a unique problem as, like young lovers, they have an insatiable desire to find and press up against each other. Some describe such magnets as “kissing magnets.” And, like love-struck fools, kissing magnets will do anything to stay together, even, for example, pushing right through the linings of internal organs. If you can picture your anatomy; imagine two different loops of bowel with a magnet in each – straining to reach each other. As the magnets are drawn together they bring the loops of bowel tightly together and create connections or holes between them (known as fistulas or perforations). So, if you have kids, magnets are no toy.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">For some time, pediatricians and consumer product safety groups have been warning about the dangers of kissing magnets. In fact, in 2008 the </span><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">Consumer Product Safety Commission (CPSC) issued new standards for children’s products and toys containing magnets. The standards require that the magnets be secured so that they will not fall out of the toy or become unattached.</span><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;"><o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">Despite this, we’re hearing about more and more kids swallowing magnets – especially neodymium magnets used as “stress relief” desk toys for adults. You may have seen these “Buckyballs” at your local Brookstone or thought of getting a set for your spouse. The magnets are generally sold in groups of 100 to 1000 and are replete with enticing shapes and colors. Although the products are labeled and designed for adults and contain prominent safety warnings, they can easily find their way into the hands and mouths of children. And while youngsters with developmental delay are known to be at higher risk for ingesting objects, many kissing magnet reports – such as a couple of those mentioned above – have occurred in developmentally normal children. As such, the CPSC has just recently filed suit to prevent the sale of Buckyball magnets by retailers.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">But, whether such products stay on the market in the long-term or not, parents, caregivers and teachers should be aware of the risks. Thus, here are some helpful tips. First, be aware of the potential complications of magnets – just because they are small doesn’t mean they aren’t capable of exerting a lot of Gauss. Second, for those who might enjoy Buckyballs or related products – keep them at work rather than at home. Third, if you suspect that a child has ingested magnets, get him or her evaluated early – magnets show up quite clearly on x-ray but a child’s symptoms won’t show up until later – when the damage is already done. Medical providers and parents should be sure to report all cases of magnet ingestion. You can visit SaferProducts.gov to report (anonymously if you prefer) injuries related to magnets or other products.&nbsp;Accurate accounting of cases can help with efforts to educate the public and maintain safety in consumer products.<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in;"><span style="font-family: Cambria; font-size: 11.0pt; mso-ascii-theme-font: minor-latin; mso-bidi-font-size: 10.0pt; mso-hansi-theme-font: minor-latin;">If you still feel a strong need to impress and amaze your friends… forget the spoons, tongue bolts, and Buckyball shapes. I suggest a different type of magnetism – one of personality – not potential perforation.&nbsp;<o:p></o:p></span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-10808594162353909032012-07-07T23:39:00.001-07:002012-07-07T23:39:58.978-07:00From your Kiwi Correspondent Part VI<br /><br /><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Over the last half year, I’ve been scrutinizing health-specific differences between Kiwi and American societies. This has been a bit of a brain-buster and I don’t feel that, to borrow a Kiwi phrase, I’ve got it “properly done and dusted.” Just when I was getting discouraged, however, I found something about health in New Zealand that’s clearly superior to back home – the Kiwis have healthier honey! <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Specifically, I’m referring to manuka honey produced by bees collecting nectar from the manuka bush (Leptospermum scoparium). This bush, which is quite plentiful throughout New Zealand, is rather ordinary looking – something like what you might expect if you crossed an azalea with rosemary. But, similar to the mold of penicillin, the manuka bush has surprising properties hidden behind its mundane appearance. Before arriving in New Zealand, I’d heard about manuka honey, but (being naturally skeptical about “natural” treatments with unnaturally ambitious claims) I’d quickly set it aside in the “I’ll research that later” bucket. It wasn’t until a couple parents of pediatric burn patients asked me whether I recommended manuka honey as a topical treatment that I actually began that research. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;"><br />When I did, I first confirmed what I already knew – that for centuries, people have utilized all types of honey for therapeutic purposes. In fact, before antibiotics were developed, honey was a common dressing for infected or non-healing wounds. But, and this was news to me, starting around about 170 years ago when the European honeybee was introduced to New Zealand (interestingly, the native New Zealand bees did not forage from the manuka bush), Kiwis began to notice that honey made from the nectar of the manuka was distinct. First of all, it was darker and richer in color and second it did not taste very good – which is why many combs of manuka honey were tossed away as useless. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Later, folks noticed a third difference – manuka honey used for medicinal purposes seemed to work better than other honey varieties. So, starting several decades ago, researchers began to investigate what makes manuka honey different. In the early 1980’s, Peter C. Molan, a biochemist at The University of Waikato in New Zealand, conducted a simple yet elegant experiment that illustrated the antibacterial activity of manuka honey. He added the enzyme catalase (present in human saliva, blood, and other tissues) to two different types of honey – traditional clover honey and manuka honey. In doing so, he disabled the hydrogen peroxide in both honeys – an important step, as up to that point, scientists credited hydrogen peroxide alone with giving honey its antibacterial properties. In Molan’s experiment, the peroxide was nullified and (as predicted) the clover honey stopped killing bacteria while the manuka honey’s antibacterial activity was unaffected. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">This discovery sent Molan and others on a 25-year quest to discover the biochemical ingredient in manuka that provides this non-peroxidase antiseptic action. Ultimately, a team from Germany stumbled across the answer – a substance called </span><em><span style="font-family: Cambria;">methylglyoxal</span></em><span class="st">. </span><span style="font-family: Times;">Meanwhile, back in New Zealand, Molan established the world’s first Honey Research Unit and unearthed many other honey secrets. Fast-forward to 2012, and Molan has compiled compelling evidence that honey is a lot more than Winnie the Pooh’s cure for a rumbly tumbly. “The only reason for being a bee,” Pooh once said, “is to make honey, and the only reason for making honey is so I can eat it.” Molan would disagree. Based on work from his laboratory and others, Molan ascribes the following therapeutic attributes to honey… (Below is a summary of published and unpublished work.) <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">• Honey stimulates white blood cells’ immune response <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">• Honey has pre-emptive antioxidant activity – it can stop potentially cell-damaging free radicals from forming. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">• Honey removes pus and dead tissue from wounds. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">• Manuka honey has these benefits as well unique antibacterial activity that is more persistent in its interaction with wound bacteria.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Additional purveyance of the literature demonstrates in vitro evidence of manuka honey’s unique action against methicillin-resistant staph aureus (MRSA). A study out of Wales by Jenkins and Cooper (Journal of Antimicrobial Chemotherapy, December 2011) found that not only does manuka honey effectively kill MRSA at low concentrations (6% weight/volume) on agar but also that it down regulates the gene (mecR1) thought to be responsible for the germ’s resistant properties. Furthermore, the investigators found in microarray analysis that a combination therapy of oxacillin and sub-inhibitory concentrations of manuka honey showed significant synergistic effects against MRSA. This, then, raises the possibility that cephalosporins combined with topical manuka honey might be a viable strategy for treating skin MRSA infections. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">So</span>, if you <span style="font-family: Times;">haven’t already, you are likely to hear more about the medicinal uses of honey, in particular, manuka honey. The FDA has now approved manuka honey (in wound dressings) and there surely are marketers out there salivating over taglines. But before you put manuka on the honey-do list, there are some not-so-sweet caveats and they start with the cost. At one Bay Area natural food store, one would need to spend $23.98 for 8.75 ounces of high-end manuka honey. And, such honey is only a tad cheaper here in the source land. Then, there is the variability in therapeutic activity. Honeybees haven’t yet agreed to be standardized and the potency of their honey differs on a batch-to-batch basis. There are rating systems in use, but they are not fully reliable. </span><span style="font-family: Calibri;"><o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Still, honey is good stuff and may be useful from head (an proven treatment for hair loss) to toe (foot ulcer dressings). And while it’s clear that manuka honey is special honey, the question is, at this point, is manuka worth the money? <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">To find out whether manuka could live up to expectations, I visited Dr. Peter C. Molan, the founder of the Honey Research Unit at the University of Waikato and the world’s foremost expert on the medicinal qualities of honey. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">I sat with Molan in his 60’s era lab, as graduate students finished up experiments around us. Molan is an oak of a man – tall and sturdy with sharp blue eyes – but warm and generous with his time and thoughts. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">“Honey took over my life,” he explained, while his students worked on separating milk caseins. “I used to do other things; it all started out as a hobby. Now I’ve been studying it for forty years.” And in those forty years, Molan has become influential and ardent in his beliefs about the medicinal benefits of honey. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Molan’s passion is based both on science and personal experience. Scientifically, Molan points to the molecular makeup and antibacterial activity of all honey as well as the specific non-peroxidase properties of manuka honey. He also explains the physiologic benefits of manuka honey as anti-inflammatory and anti-oxidant&nbsp; – including the inhibition of phagocytosis in wounds, especially burns. Personally, Molan calls upon the examples of friends, family, and strangers to whom he’s recommended honey over the years and the stories they’ve brought back to him. For example, Molan’s wife used manuka honey to treat a severe scald burn and one of his friends has successfully tempered his sour stomach by having a spoonful of honey every night before his wine.&nbsp; <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">But, there is melancholy in Molan when he speaks about manuka – he laments the reluctance of the medical world to buy into therapeutic honey. “Evidence based medicine – everyone says they support it – but in reality they only buy into something they have a rationale for. ” Even in New Zealand, manuka honey is not considered a frontline treatment for wounds by the district health boards – due primarily to cost considerations (the exception being Molan’s home district of Waikato.) Another frustration for Molan is the commercialization of the manuka honey market – in particular the manipulation of rating systems and widespread disingenuous marketing. For example, says Molan, </span><span style="font-family: Times;">there is now honey being sold as “Active Manuka Honey,” but the “activity” the seller is referring to is the antibacterial activity (due to hydrogen peroxide) that is present in all honey, not the non-peroxide type of antibacterial activity that is unique to manuka honey.</span><span style="font-family: Times; font-size: 10pt;"><o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">When I ask Molan the critical question – is manuka honey worth the money – he hesitates for a moment. “</span><span style="font-family: 'Times New Roman';">If you look at the total cost,” he responds, “which means taking into account the time to healing, and thus the total number of dressings needed and the cost of the staff time and facilities – there is a huge saving to be made by using manuka honey if it is used in a ‘best practice’ method.” </span><span style="font-family: Times;"><o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Molan is certainly the world expert on this topic, but he also has a bit of an insular view as well as a potential conflict of interest (which he readily admits) as the owner of patents on honey, including on a manuka honey impregnated wound dressing. So, he may not be completely seeing the comb for the bees. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Here then, is the bottom line on what <i style="mso-bidi-font-style: normal;">I </i>have concluded about honey, and in particular manuka honey. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">*Honey, any honey, might be beneficial for simple sunburns, superficial burns, heartburn-like sour stomach, and cold symptoms.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">*The level of scientific proof on these benefits is mixed, although the risk of use is probably pretty low – although it is still prudent to follow the advice of the American Academy of Pediatrics and avoid feeding honey (any raw honey) to children under the age of one due to the small risk of contracting botulism.<o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">*For open wounds and severe burns, manuka honey is almost certainly superior to regular honey – but if patients are buying it over-the-counter, it will be both expensive and fraught with the potential for misinterpretation of activity. Also, be aware, as a Kiwi plastic surgeon told me, that honey applied to open wounds may sting quite a bit. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">*Gamma irradiated manuka wound dressings hold promise, especially for pressure wounds and complicated burns that are not healing with standard treatment and dressings (like hydrocolloid or silver-impregnated dressings.) In this regard, the American market is still evolving. <o:p></o:p></span></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">So, there you go, as crystal clear as a manuka mud bath. Indeed, if the therapeutic use of honey interests you (or your patients), it appears you will just have to stay tuned to see how both the science and the business sort themselves out. Until then, as Pooh says “Oh yes, I'm rumbly in my tumbly. Time for something sweet.”<o:p></o:p></span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-23445577377667306512012-05-26T11:51:00.001-07:002012-05-26T11:51:12.314-07:00Notes from New Zealand; Green Prescriptions<br />I recently received this media statement from the Kiwi Health Minister, promoting the green prescription program. This can be the most important prescription a doctor writes for their patient...<br /><br /> <!--[if gte mso 9]><xml> <o:DocumentProperties> <o:Template>Normal.dotm</o:Template> <o:Revision>0</o:Revision> <o:TotalTime>0</o:TotalTime> <o:Pages>1</o:Pages> <o:Words>311</o:Words> <o:Characters>1776</o:Characters> <o:Company>Angela Ballard Writing</o:Company> <o:Lines>14</o:Lines> <o:Paragraphs>3</o:Paragraphs> <o:CharactersWithSpaces>2181</o:CharactersWithSpaces> <o:Version>12.0</o:Version> </o:DocumentProperties> <o:OfficeDocumentSettings> <o:AllowPNG/> </o:OfficeDocumentSettings></xml><![endif]--><!--[if gte mso 9]><xml> <w:WordDocument> <w:Zoom>0</w:Zoom> <w:TrackMoves>false</w:TrackMoves> <w:TrackFormatting/> <w:PunctuationKerning/> <w:DrawingGridHorizontalSpacing>18 pt</w:DrawingGridHorizontalSpacing> <w:DrawingGridVerticalSpacing>18 pt</w:DrawingGridVerticalSpacing> <w:DisplayHorizontalDrawingGridEvery>0</w:DisplayHorizontalDrawingGridEvery> <w:DisplayVerticalDrawingGridEvery>0</w:DisplayVerticalDrawingGridEvery> <w:ValidateAgainstSchemas/> <w:SaveIfXMLInvalid>false</w:SaveIfXMLInvalid> <w:IgnoreMixedContent>false</w:IgnoreMixedContent> <w:AlwaysShowPlaceholderText>false</w:AlwaysShowPlaceholderText> <w:Compatibility> <w:BreakWrappedTables/> <w:DontGrowAutofit/> <w:DontAutofitConstrainedTables/> <w:DontVertAlignInTxbx/> </w:Compatibility> </w:WordDocument></xml><![endif]--><!--[if gte mso 9]><xml> <w:LatentStyles DefLockedState="false" LatentStyleCount="276"> </w:LatentStyles></xml><![endif]--> <!--[if gte mso 10]><style> /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0in 5.4pt 0in 5.4pt; mso-para-margin-top:0in; mso-para-margin-right:0in; mso-para-margin-bottom:10.0pt; mso-para-margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin;} </style><![endif]--> <!--StartFragment--><span style="font-family: &quot;Times New Roman&quot;; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Cambria; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">"Many keen for green prescribing<br /><br /></span><br /><span style="font-family: &quot;Times New Roman&quot;; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Cambria; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">The benefit to patients from following doctors’ orders for regular exercise is highlighted in a publication launched today by Health Minister Tony Ryall.<br />“Last year GPs and practice nurses issued 32,028 people with a Green Prescription to become more physically active, an increase of 5,868 people since 2008. Over 80 per cent of GPs in the country have issued Green Prescriptions.<br /><br />The internationally recognised Green Prescriptions are a health professional’s written advice to encourage and support patients to exercise regularly as part of a total health plan. The main activities prescribed are walking, swimming and gym exercises.<br /><br />“The top three reasons people are given a Green Prescription are weight problems, high blood pressure and risk of stroke or diabetes.<br /><br />“A survey this year shows 73 per cent of people noticed improvements in their health six to eight months after receiving their Green Prescription.<br /><br />“The online publication tells 10 patient stories - each one showing how regular exercise has had significant benefits in the person’s life.<br /><br />“It also includes a story from our own Olympic great Sir Peter Snell who describes regular physical exercise as the closest we can get to immortality – and after reading the patient stories it’s easy to understand his enthusiasm.<br /><br />“Since receiving his Green Prescription, Northland man Andrew Riwhi-Moiha has lost 22 kilograms, reduced his blood pressure and no longer needs to take as much diabetes medication.<br /><br />Health Minister Tony Ryall says the National Government’s Green Prescription initiative is getting more New Zealanders active and significantly improving their health.<br /></span><span style="font-family: &quot;Times New Roman&quot;; font-size: 12.0pt; mso-ansi-language: EN-US; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-theme-font: minor-bidi; mso-fareast-font-family: Cambria; mso-fareast-language: EN-US; mso-fareast-theme-font: minor-latin;">The patient stories can be read or watched on the Ministry website.</span><br /><br /><br /><br /><br /><!--EndFragment-->DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-88621877517877086122012-05-02T14:57:00.000-07:002012-05-02T14:57:27.499-07:00From your Kiwi Correspondent Part V<style id="dynCom" type="text/css"><!-- --></style> <br /><style><!-- /* Font Definitions */ @font-face {font-family:Arial; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman"; mso-ansi-language:EN-GB; mso-fareast-language:EN-GB;} p.MsoCommentText, li.MsoCommentText, div.MsoCommentText {mso-style-link:"Comment Text Char"; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman"; mso-ansi-language:EN-GB; mso-fareast-language:EN-GB;} span.MsoCommentReference {mso-ansi-font-size:9.0pt; mso-bidi-font-size:9.0pt;} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {mso-style-noshow:yes; color:purple; text-decoration:underline; text-underline:single;} p {margin-top:0in; margin-right:0in; margin-bottom:9.0pt; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman"; mso-ansi-language:EN-GB; mso-fareast-language:EN-GB;} p.Default, li.Default, div.Default {mso-style-name:Default; mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:none; mso-layout-grid-align:none; text-autospace:none; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman"; color:black; mso-ansi-language:EN-US; mso-fareast-language:EN-US;} span.CommentTextChar {mso-style-name:"Comment Text Char"; mso-style-locked:yes; mso-style-link:"Comment Text"; mso-ansi-font-size:12.0pt; mso-bidi-font-size:12.0pt; mso-ansi-language:EN-GB; mso-fareast-language:EN-GB;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br /><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span lang="EN-GB" style="color: #333333; font-family: Cambria;"></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">Here in New Zealand, I often reflect on October 2010. You may recall that month; the fall colors were black and orange and the season was flush with fearful beards and late-inning “torture.” During those pennant-winning weeks, the cauldron of Giants baseball fever hovered between bubble and froth and our community had cohesion of purpose unlike I’d seen before. </span></div><div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">So why is it that half-a-world away (where virtually no one knows the difference between a slider and a curveball) I’m consistently reminded of the 2010 World Champs? Well, it’s because the fervour of fall ’10 is replicated daily in New Zealand but for a much different sport: rugby.&nbsp;</span></div><div class="MsoNormal" style="background: none repeat scroll 0% 0% white;"><br /></div><div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">New Zealand has been a rugby nation since shortly after its incorporation into the Crown territories in the early19<sup>th</sup> century. The British, you see, were intent on avoiding the opulent mentality that plagued prior empires, and so chose a formidable and stoic sport to promote throughout their colonies. I don’t know how successful this tactic was elsewhere, but in New Zealand the game – and its paradigm – took root.. According to Dr. Robin McConnell</span><span class="MsoCommentReference"><span lang="EN-GB" style="color: #17365d; font-family: Cambria; font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_1" id="_anchor_1" name="_msoanchor_1"></a></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">, in his profile <i style="mso-bidi-font-style: normal;">Inside the All Blacks</i>, </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">rugby “shapes New Zealand social history and everyday life</span><span class="MsoCommentReference"><span lang="EN-GB" style="color: #17365d; font-family: Cambria; font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_2" id="_anchor_2" name="_msoanchor_2"></a><span style="display: none;"> </span></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">.” Case in point -- it’s been </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">five months since the New Zealand national team won the Rugby World Cup on home turf, yet the All Blacks remain ubiquitous. Flags, some homemade, fly from car antennas and balconies, babies don All Black onesies, and bottles of the nation’s top selling beer (Steinlager) declare “All Blacks…25 Years of Unconditional Support.” Looking for front-page news? Any snippet&nbsp; about a present or former All Blacks player will do. Did you know that the legendary Michael Jones is helping to bring a Carl’s Jr. franchise to New Zealand?</span></div><div class="MsoNormal" style="background: none repeat scroll 0% 0% white;"><br /></div><div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">The All Blacks are a national team and rugby a national sport in New Zealand – and we really have nothing comparable in the U.S., especially in terms of unity of loyalty. Given size and diversity differences between the two countries, this may not seem a fair comparison but it nonetheless raises the question of whether this shared passion for, and culture of, rugby pervades Kiwi life beyond the pitch? And in particular, does it help make Kiwis happier and healthier?</span></div><div class="MsoNormal" style="background: none repeat scroll 0% 0% white;"><br /></div><div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">If you ask my wife, rugby is defined as a sport played by short men wearing too short shorts around gigantic thighs. But to others, it is defined by discipline, masculinity and stoicism. It is the type of sport in which a player (true story) might insist on playing </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">most of a match with one testicle hanging torn from his scrotum. Stories like this are common and lead one to believe that the stoicism of Kiwis is unparalleled – an observation that finds some support in medical studies on pain tolerance. It could be that rugby plays a role in the Kiwi approach to death and dying [which is?]– one that, anecdotally at least, is more accepting than that of many other countries. Additionally, the national morale may be boosted by shared enthusiasm over rugby, which, in turn, can benefit the collective welfare. </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">Indeed if you were to ask psychologist Jonathan Haidt, author of <i style="mso-bidi-font-style: normal;">The Righteous Mind,</i> Kiwi rugby culture might represent a classic case of sacredness of the group - “People who worship the same idol can trust one another, work as a team and prevail over less cohesive groups.”&nbsp;</span></div><div class="MsoNormal" style="background: none repeat scroll 0% 0% white;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">&nbsp;</span><span class="MsoCommentReference"><span lang="EN-GB" style="color: #17365d; font-family: Cambria; font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_3" id="_anchor_3" name="_msoanchor_3"></a><span style="display: none;"> </span></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;"></span></div><div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">But some argue that any such benefits are greatly overwhelmed by rugby’s culture of rowdiness, drunkenness and intolerance. In fact, just as there are Kiwis who live for rugby, there are those who detest it. One blogger, </span><span class="MsoCommentReference"><span lang="EN-GB" style="color: #17365d; font-family: Cambria; font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_4" id="_anchor_4" name="_msoanchor_4"></a><span style="display: none;"> </span></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">in a piece entitled “NZ Rugby Morally Bereft,” writes that </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">rugby “promotes machocism, alcoholism, violence, sexism and colonialism. Rugby has also created a crippling crisis in our health sector.” There is certainly truth to the first statement – the only rugby match I’ve ever attended hosted a highly intoxicated crowd, and I won’t even attempt to describe the </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">experience of visiting a stadium urinal. But while injuries are common, I can’t believe that they are a crippling crisis. Rugby may have a higher injury rate than many other sports, and concussions</span><span class="MsoCommentReference"><span lang="EN-GB" style="color: #17365d; font-family: Cambria; font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_5" id="_anchor_5" name="_msoanchor_5"></a></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;"> (especially under-reported concussions)&nbsp;</span><span class="MsoCommentReference"><span lang="EN-GB" style="color: #17365d; font-family: Cambria; font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_6" id="_anchor_6" name="_msoanchor_6"></a><span style="display: none;"> </span></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">are of particular concern, but the rates of devastating injuries such as spinal cord injury are actually not that high. A review of nationwide injury claims related to rugby from 1999-2007 reports an average of 743 a year, most of them limb and soft-tissue injuries, with a rather (given the nature of health expenses) modest yearly cost of $5.3 million</span><span class="MsoCommentReference"><span lang="EN-GB" style="font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_7" id="_anchor_7" name="_msoanchor_7"></a></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">.&nbsp;</span></div><div class="MsoNormal" style="background: none repeat scroll 0% 0% white;"><br /></div><div class="MsoNormal" style="background: white; mso-margin-bottom-alt: auto; mso-margin-top-alt: auto; mso-outline-level: 3;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">One of the few academics that has closely studied and written about the cultural and societal effects of Kiwi rugby is Brendan </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">Hokowhitu, an associate dean at University of Otago. He shares a rather bleak assessment of the health effects of the sport. </span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">“I wouldn't say there is anything historically at least positive about New Zealand rugby culture and health,” he wrote. “Rugby was very much part of the establishment and was as such quite oppressive of women and alterity&nbsp;</span><span class="MsoCommentReference"><span lang="EN-GB" style="color: #17365d; font-family: Cambria; font-size: 9pt;"><a class="msocomanchor" href="http://www.blogger.com/blogger.g?blogID=2810266452851494301#_msocom_8" id="_anchor_8" name="_msoanchor_8"></a><span style="display: none;"> </span></span></span><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">[cultural freedom] in general.”</span></div><div class="MsoNormal" style="background: none repeat scroll 0% 0% white;"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span lang="EN-GB" style="color: #17365d; font-family: Cambria;">So the All Blacks culture does have a black side. But, to reiterate, the cohesiveness of the culture certainly has positive effects regarding national identity and group mentality. New Zealanders consistently score highly in international surveys of happiness and a nationwide social survey of 8,000 Kiwis found very high levels of people feeling like they “belong to New Zealand.” Another survey, of about 6,000, conducted by psychologist Marc Wilson of Victoria University of Wellington, found that Kiwi respondents with stronger identification to rugby reported being happier, more optimistic and having higher self-esteem. The beneficial effects of happiness on health are both obvious and well documented, and should not be underestimated. I wonder if the rugby in rugby culture could be replaced with a group activity with fewer downsides? Could a less dangerous and less rambunctious diversion replace rugby? Golf is popular here – so perhaps the All Greens might substitute. When it comes to group identity, however, such a change is much easier to talk about than to make. It’s a bit like asking a Giants fan to take up an L.A. Dodger habit.</span></div><div style="mso-element: comment-list;"><hr align="left" class="msocomoff" size="1" width="33%" /><div style="mso-element: comment;"><div class="msocomtxt" id="_com_1"><a href="http://www.blogger.com/blogger.g?blogID=2810266452851494301" name="_msocom_1"></a><span style="background: none repeat scroll 0% 0% yellow; font-family: Cambria;"></span><span style="font-family: Cambria;"></span></div></div><div style="mso-element: comment;"><div class="msocomtxt" id="_com_2"><div class="MsoCommentText"><br /></div></div></div></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-22828299498193134892012-04-19T17:29:00.002-07:002012-04-19T19:18:26.408-07:00From your Kiwi Correspondent Part IV<div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">For a week after arriving in New Zealand, Holden, my three-year old son, was truly out-of-sorts. He was consistently cranky, refused to walk the city sidewalks, and frequently directed abusive behaviour towards his sister and the hotel furnishings. Disturbed, we convened a family summit on how to make him right. Holden suggested “bad guy” toys and his sister proposed gummy worms, but ultimately we settled on the parental preference: pharmaceuticals. My wife, based on prior experience, was concerned that Holden had an ear infection and I was concerned both about waking up at four in the morning and also about lugging a 30-pound child to and from the immigration office to complete visa paperwork. So, we agreed on a compromise – a liquid painkiller called Auralgan for his ears. We decided on this despite the lack of evidence that Holden actually had an ear infection and despite a strong suspicion that moving halfway around the world might have a significant psychological impact on a three-year old.&nbsp;</span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">I was pleasantly surprised to find a local pharmacy that carried Auralgan but taken aback when the pharmacist began to quiz me about my choice. She was (rightfully) dubious about Holden’s diagnosis, and it wasn’t until I explained that I was a physician (and that I believed in the placebo effect), that she finally relented and <i>allowed me</i> to pay $20 for a small bottle of medication.&nbsp;</span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">Afterwards, it occurred to me that this interaction would have gone quite differently back home, where purchasing over-the-counter medications usually only elicits questions like “Do you have a Rite Aid Saver Card?” I soon started noticing other differences, as well. &nbsp;One was quite striking – the absence of drug advertising. No billboards for antacids, no magazine spreads for cholesterol pills, and no wacky television commercials with beavers, Abraham Lincoln and insomnia prescriptions.&nbsp; At work in the Emergency Department, I noticed a simpler approach to prescriptions – fewer choices, shorter medication lists, fewer narcotics, and for the children: “play therapists” to supplement pain control during procedures. Among all patients, I heard far fewer concerns about the meds they could or could not afford to purchase.</span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">In short, it became clear that medications are less prominent in Kiwi society than in America. Why might that be? Well, first off, while direct to consumer pharmaceutical advertising is legal in both countries, it is uncommon in New Zealand with Kiwi television ad time being reserved for truly important products like Marmite (did you hear that there’s a shortage?) Americans, however, cannot avoid drug ads – U.S. pharmaceutical companies spend over $5 billion a year on them and the typical American will spend around sixteen hours each year watching television snippets for drugs. But, more importantly, the structure and incentives regarding prescription medications are distinct. In the U.S., a premium is put on choice and novelty, at the expense of, well, expense. Sure, there are drastic differences between insurers and public assistance programs, but as a nation we spend a lot of money on prescription drugs – something like $300 billion dollars, which works out to about 13% of all health care costs (the highest rate in the world.)&nbsp; </span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">In New Zealand, there is a smaller pharmaceutical budget and unified approach under a national formulary. Created in 1993 in response to rapidly rising drug prices, the Pharmaceutical Management Agency (PHARMAC) recognizes that for some common conditions there are a handful of medications that perform equally as well, and some of these are cheaper generic brands. For example, a patient with high cholesterol has many choices of “statins” – Lipitor, Mevacor, Crestor, etc. – that all work through the same molecular mechanism. In circumstances such as this, and with the input from multiple physician-staffed committees and sub-committees, PHARMAC negotiates with the makers of those medications to get the best value for the money. The result is that a narrow list of medications (often just one) becomes the subsidized choices for that condition and when patients are prescribed one of these they pay a nominal pharmacy charge (between $0 and $3). So, rather than seven statins to choose from, the Kiwis have just three (which seems enough to me).</span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">Of course, if a customer truly desired a different statin, he or she could almost surely pay more to get it. Many large U.S. insurers function in a similar manner regarding formulary and non-formulary medications. But because PHARMAC is negotiating for an entire market of 4.5 million people, they have a reasonable chance of striking a good deal with the drug makers. And financially, at least, PHARMAC has been a success. PHARMAC reports saving $4.7 billion since year 2000, whilst increasing its purchasing power threefold since 1993. This success has allowed the organization to expand funding of specialized and novel medications (for exceptional circumstances). An example is the funding of a new blood thinner called dabigatran for the treatment of atrial fibrillation (this by the way may turn out to be a mistake, but more about that another time.)&nbsp;</span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div class="MsoNormal" style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">Although the cost efficiency is difficult to argue with, not everyone is keen on the PHARMAC model or its decisions. A recent funding switch regarding glucometers for diabetics is an example. Some worry that the newly subsidized glucometer will not work well for everyone and thus not be worth the projected ten million dollars in savings. In the words of one parent to TVNZ…</span></div><div class="MsoNormal" style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">"We are sheep farmers in a rural area. If I have to call for an ambulance for my daughter the first thing they are going to ask me is what her blood sugar levels are. If I haven't got an accurate meter to tell them, the consequences will be drastic."&nbsp;</span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">But despite flares like this, in general, it does not seem like having fewer pharmaceutical choices bothers the average Kiwi. I asked an Auckland pharmacist if her customers seemed happy with the medication choices they had. “Well, sure they do,” she replied, “but they don’t have much of a choice about that, now do they?” And I must admit that, as a physician, it is sometimes rather nice to have a short and sweet list of prescribing options. This approach seems to lessen the risk of gratuitous medication prescribing and there is less emphasis on pharmaceuticals – with the Kiwi perception of health being, if you will, less drugged out.</span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">This is not to say that one approach or perception is necessarily superior to the other – indeed the Kiwi approach would probably not be possible without the American one. Pharmaceutical companies need markets for new drugs, after all, and we all benefit from them staying in the business of making lifesaving treatments such as vaccines, insulin and antibiotics.&nbsp;</span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span lang="EN-GB" style="font-size: small;">So, you may be wondering, did those eardrops help little Holden? We’ll never know the answer. Ultimately, his mom and I demurred and went with bad guy toys and gummy worms instead. And I am happy to report that this worked quite well. Could it be that those who haven’t been fully indoctrinated into the “pill for every problem” lifestyle might be onto something? Maybe we can all do with a little more “play therapy.”</span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div style="font-family: inherit;"><span style="font-size: small;"><br /></span></div><div class="MsoNormal" style="font-family: inherit;"><span style="font-size: small;"><br /></span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-69608643602938069422012-03-19T14:12:00.004-07:002012-04-19T17:33:23.244-07:00From your Kiwi Correspondent Part III<span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span><br /><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Imagine that you’ve driven your car off the road and into a Eucalyptus tree and busted up your ankle. During the subsequent ambulance ride, what thoughts might pop into your head?<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">&nbsp;“Ouch!”<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">“Thank goodness no one else was hurt.”<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">“<i style="mso-bidi-font-style: normal;">What in the heck</i> were those possums doing?”<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">“I’ve never liked Eucalyptus trees.”<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">“How in the world am I going to pay my medical bill?”<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">A Marin County resident could conceivably have some, or all, of these thoughts. But here in New Zealand, at least one of these notions would be quite unusual. And no, it’s not the one about possums – they are as plentiful as sheep around these parts. Rather, it is the bit about medical costs. You see in New Zealand, accident and injury-related medical care is fully compensated – regardless of insurance or fault. More about that soon, but first, for those who may have missed my last column, a quick catch-up…I’m in the midst of a six-month stay in Auckland, grappling with how Kiwi perceptions of health and wellness differ from American ones. Now, I recognize (disclaimer alert!) that perceptions of health are diverse and that this endeavor hazards broad generalizations. Perhaps my query is as unanswerable as the age-old “nature versus nurture debate.” Nonetheless, there are identifiable differences in geography, culture and statute that would seem to shape how health is perceived in these two countries. <o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Let’s return to the example of medical care for the wounded. We all know that some injured patients in the U.S. just cannot pay for healthcare, but that eventually (probably in an ER) they are likely to receive treatment anyway.&nbsp; Everyone else picks up the tab for this through higher insurance premiums and other cost shifting. Of course, in some cases, it’s not that simple. For example, some uninsured patients might be able to pay their medical bills, but risk bankruptcy in the process. <o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Injuries are handled quite differently in New Zealand under a system called the Accident Compensation Corporation (ACC). First enacted in 1974 and revised many times since then, the ACC hinges on a crucial trade off – free medical care for injuries (regardless of fault) for all citizens and non-citizens alike in return for higher taxes and, importantly, forfeiture of the right to sue for damages. <o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Here’s how it works… let’s say an American tourist tries Zorbing – a “sport” in which you are rolled down a hill inside a large plastic sphere that looks like an overfed yoga ball. This American then suffers an unscheduled tumble into the path of a campervan. When he is taken to the Accident and Emergency (aka, the ER), the physician will complete an ACC form, verifying that he has sustained a valid injury and that his medical care will be paid for by the ACC. In return, said American cannot sue the Zorbing company, the driver of the campervan, the physician who treats him, or anyone else. He can, however, take solace in the fact that if any of these parties has acted negligently, they may be criminally prosecuted (as opposed to sued). <o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">This system, it seems to me, helps mitigate fear. I’ve noticed this on many levels but it’s most pronounced with the children. There is a tool bench at my son’s preschool and it’s equipped with actual carpenter-worthy hammers, screwdrivers, nails, and Philips heads for actual building projects (take that Bob the Builder!) The kids go shoeless much of the day – they take their kicks off when they arrive at school and&nbsp; (maybe) put them back on when they leave (of course the lack of poisonous snakes or spiders helps make this a safer proposition than it might be elsewhere). Trampolines and “bouncing pillows” are common, as are the injuries they cause. Kids play rugby, without helmets, which does not seem like a good idea to me. For young adults, the fearlessness manifests in adventure sports such as white water river sledging (river rafting on a boogie board). But it’s in professional life where diminished fear may make the most substantive difference. Kiwis I’ve spoken to are amazed at the thought of staying in a bum job just because it offers good health coverage. An American physician who spent a decade in New Zealand put it this way, “we [Americans] have to buy protection against the health care system that could make us poor. They have freedom from that fear.” Of course, these are perceptions, not hard facts, and fear (especially the type that softly itches at you each day) is a hard thing to measure objectively. <o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">There are certainly downsides to the ACC scheme – a 2% earner’s levy (income tax) which caps at approximately $2000/year/person as well as the potential for both fraud and reckless behavior. As to the latter, Kiwis are certainly adventurous, but not particularly reckless. The roads are safe and well-policed and fatal motor vehicle accidents rare (396 in all of 2008) and less frequent (per vehicle) than in the U.S. &nbsp;And, while I see far more unhelmeted cyclists here than at home, I also note far fewer folks texting while behind the wheel. Any freedom that an individual might feel to act carelessly seems to be more than counterbalanced by a public health incentive (financial and otherwise) to prevent severe injuries. The only truly reckless activity I’ve heard about is as a coed rugby squad called the Nude Blacks (if that isn’t explanation enough, there are YouTube videos.)<o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">“Normal fear protects us; abnormal fear paralyses us,” so wrote Marin Luther King Jr. True enough, but what is “normal,” and how much is it defined by the social contract of the society in which we live?</span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">It would seem that American society creates certain “abnormal” fears that may not exist in New Zealand. And this might help explain differences between the two peoples in regard to how they view their health. It does not, however, explain what the heck those possums were doing in the the road.</span><span class="Apple-style-span" style="font-family: Cambria;"><o:p></o:p></span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-84360564347240442162012-03-19T14:06:00.001-07:002012-04-19T17:33:48.111-07:00From your Kiwi Correspondent Part II<span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span><br /><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Soon after arriving in Auckland for a six-month sojourn, I picked up the local paper (<i style="mso-bidi-font-style: normal;">The New Zealand Herald</i>) and was surprised to read this from columnist Paul Holmes… <b>&nbsp;</b><b><o:p></o:p></b></span></div><div class="MsoNormal"><b><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></b></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><b>“Now, my health.</b>It seems to have been a matter of speculation since last Sunday and I don't want you to think I'm on my last legs, so here's what happened…It was all to do with damage done by radiotherapy during the first days of the prostate cancer treatment a decade ago…<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Times,'Times New Roman',serif;">In mid January, my bladder shut down. That is to say, its ability to drain itself was blocked by an enlarged prostate strangling the urethra. So I could not pee. Meantime the bladder continued to swell and believe me, this must be one of the most painful conditions in the world. The immediate solution is to insert a catheter to drain the bladder, a moment of immense relief. And you walk round with the bag attached to your leg until they can do what I call a re-bore.<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Times,'Times New Roman',serif;">Sounds weird and unpleasant I know, but it's happened to me now a few times over the years and you kind of get used to it.<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">But it's what can happen after prostate cancer. Like any cancer, it is a nasty, unpredictable thing, and its effects can hang round for years and change your life forever.” <o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Times,'Times New Roman',serif;">I read this, and then re-read it to be sure. Did a prominent newspaperman just describe a personal and painful medical condition in a public and matter of fact manner? Why, yes, he had. And it occurred to me that one would be hard pressed to read such an account in the mainstream American media. This in turn had me asking, are we Americans a bit squeamish about our health? You certainly don’t see much about bladder blockage on the opinion page of the <i style="mso-bidi-font-style: normal;">New York Times</i>, but it’s not just that. Rightly or wrongly, many Americans would prefer to keep matters of reproductive and mental health (among others) in a black box. For instance, I would wager that there are precious few (if any) U.S. neighborhoods that feature billboards urging men to…“Give it a shot, there’s a 1,000,001 reasons to be a donor.” Sperm donor, that is. Such billboards are abundant here in Auckland. You also are unlikely to find your local paper running a feature on male cosmetic surgery, entitled “Beauty and the bloke.”<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">What you will find in the U.S. is a large number of people addicted to prescription narcotics. But while the U.S. is facing an unprecedented epidemic of prescription drug mis-use and abuse (prescription narcotic-related deaths numbered 14,800 in year 2008), what there is of Kiwi statistics on the topic suggests it is nary a problem here. The most recent published report I could find documents 92 prescription drug abuse deaths in the whole of New Zealand for the entire 2001-2002 time period. Why the difference? From my observations so far, and from what people tell me, it seems that Kiwis with chronic pain are better able to manage their pain with a regiment of Tylenol and the occasional happy hour. Or it could have something to do with the fact that hydrocodone is not available here in New Zealand. When I asked a Kiwi physician about this drug, she replied “No, haven’t heard of it. Related to morphine is it?”<o:p></o:p></span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">But, there could be more to it. Limited investigation, some of it quite dated, suggests that there are cultural differences between Americans and Kiwis when it comes to pain perception and disability. A comparison study (Carron et al, 1984) of one hundred some chronic low back pain in each country indicated that “despite nearly similar between-country reports of pain frequency and intensity, the U.S. patients, both at pre- and post-testing, reported greater emotional and behavioral disruption as a correlate of their pain.” A more recent qualitative study (Dean et al, 2011) of rural Kiwi workers with low back pain observed a return-to-work ethic in spite of pain driven by a “‘can do’ attitude to work, managing [low back pain] within the context of having job control and flexible work practices.” <o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Times,'Times New Roman',serif;">Am I saying that Americans are prudes and wimps when it comes to health? No, I have no such authority and we Americans would have no such monopoly. Besides, who’s to say that health squeamishness is a detrimental trait? I’m just pondering why there appears to be a health-minded difference between New Zealanders and Americans?<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Times,'Times New Roman',serif;">Over the next half dozen or so columns, I will explore various angles and nuances of this question – incorporating stories and observations from New Zealand and relating them, when applicable, back to the U.S. system. In the process, I hope not to, as a Kiwi might say, “Make you a whole lot of knackered,” which translates loosely to “bore you to sleep.”<o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Times,'Times New Roman',serif;">To start this endeavor off, we must address size and population density. New Zealand is a country roughly half the size California with only 4.5 million people. By way of comparison, the San Francisco Bay Area registers just about this many all by itself. <o:p></o:p></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">As Don, a rather sharp-tongued tour guide told us… “Four-point-five million, that is not so many that you couldn’t fit them all in your backyard and still have room for a game of golf.” To put this in perspective, topics make it into <i style="mso-bidi-font-style: normal;">The New Zealand Herald</i> that would surely be drowned out by other news in the U.S. For instance, it’s front section news that a woman “abducted” a newborn baby from its mother – after asking and receiving permission to take the baby for a stroll. Articles also appear regularly about hospital food and clothing. The sticky stripe socks are, by the way, considered a smashing success!&nbsp; <o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">New Zealand, however, does have a high profile epidemic in progress. A nationwide surge of late night chip (French fry) cooking–induced house fires (1,005 of them in 2008-2009) prompted the Kiwis to launch a public service campaign called “Don’t drink and fry.” If you have a moment, pull up the TV ads on YouTube, they are richly entertaining. Somewhat remarkably, this campaign seems to have contributed to a nearly 40% decrease in frying fires in 2009-2010. <o:p></o:p></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">So size matters – both in the nature of what’s news and what demands public health attention. But, there is more to this topic of comparative squeamishness than that. Next time, I will explore the role of fear – in particular the fear of losing health coverage or not having it all – and how this impacts a culture’s approach to health and wellness.&nbsp;</span><span class="Apple-style-span" style="font-family: Cambria;"><o:p></o:p></span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-24697966577680812032012-03-19T14:04:00.000-07:002012-04-19T17:35:17.707-07:00From your Kiwi Correspondent Part I<div style="text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal" style="text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">“Hello there, this is your captain speaking. Today, we’re going to skip the details about your personal flotation device… if you find yourself needing that, well, talk about one in a bazillion…And <i style="mso-bidi-font-style: normal;">I</i> know that <i style="mso-bidi-font-style: normal;">you</i> know how to click together a bloody seatbelt. Our seatbelts work like every other one you’ve ever used, and if you can’t figure it out, well, perhaps you shouldn’t be out in public in an unsupervised fashion. So instead, why don’t you pay attention to some health tips that might actually be useful.”</span></div><div class="MsoNormal" style="text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Don’t you wish airline pilots would give it to you straight like that? I sure do.&nbsp;</span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Recently, I took a twelve-hour flight from Los Angeles to Auckland, New Zealand and, as it turns out, twelve hours is a long time to spend on a plane. Especially if you’re seated next to a hulking rugby player whose taut triceps nudge you into an awkward diagonal position. The good news is that this (seemingly interminable) discomfort gave me plenty of time to consider what is really worrisome about an extended plane flight. And you know what, the location of the personal flotation device is not high on the list. In fact, the Transportation Safety Board of Canada, among others, has concluded that even in the rare circumstance that such a device be required, it is highly unlikely that it will be used unless the passenger is <i style="mso-bidi-font-style: normal;">actually</i> wearing it beforehand. And since I’m not interested in advice (such as wearing a life vest for the duration of an overseas flight) that makes flying even more uncomfortable, we shall focus on more tangible threats.&nbsp; </span><br /><span style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoListParagraph" style="text-align: left; text-indent: -0.25in;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">1<span style="font: 7pt 'Times New Roman';">&nbsp; &nbsp; &nbsp; &nbsp;</span><b>Deep Vein Thrombosis (DVT):</b> “Stretch your bloody legs.”</span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">We all know that DVT is a common and potentially deadly condition and that prolonged immobility is a major risk factor. But how common is the airline DVT, dubbed by some as “Economy Class Syndrome”? We don’t know for certain, but some estimates are staggering. In 2001, <i style="mso-bidi-font-style: normal;">The Lancet </i>(Scurr et al) published an analysis estimating that one million cases of DVT related to air travel occur in the U.S. each year and that 100,000 of these result in death. A more recent review article by Gavish and Brenner put the risk on long-haul flights (6 ½ hours or longer) at 3-12%. This is a pretty stunning incidence – equaling approximately one DVT per one to four rows of economy seats in a Boeing 777. The American College of Chest Physicians (ACCP), on the other hand, have – in both their 2008 and 2012 guidelines – estimated a lower incidence, calling the risk “mild.” It’s thought that the risk of DVT is due not only to in-flight immobility but also the relative hypoxia in the cabin. As with all DVTs, risk factors include age over 40 years, female gender, pregnancy, oral contraceptive use, lower limb varicose veins, obesity, and genetic thrombophilia. The ACCP has recently added sitting in window seats to this list (Grade 2C evidence) while also observing that “Economy Class Syndrome” may be a misnomer – those in first class have the same DVT risk as those in the back of the plane. Notably, even the absence of risk factors does not put you in the clear. A Norwegian study (<i style="mso-bidi-font-style: normal;">The</i> <i style="mso-bidi-font-style: normal;">Lancet</i>, 2000) observed a substantial hour-by-hour increase in blood clotting factors (2-8 fold) occurred in all twenty healthy subjects studied in a simulated (hypobaric) environment. <o:p></o:p></span></div><div style="margin: 0.1pt 0in 0.1pt 0.25in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Clearly, even if Economy Class Syndrome is a misnomer and some incidence estimates overblown, it seems that DVT prevention advice would be a useful aspect of an in-flight safety program (more helpful, perhaps, than a reminder to stow your tray table in an upright position.) <o:p></o:p></span></div><div style="margin: 0.1pt 0in 0.1pt 0.25in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">The trick to prevention, as we all know, is to keep those bloody legs moving! Any combination of the following will help: 1) graduated compression stockings for high risk patients at 15-30 mg of Hg, 2) calf and ankle exercises such as pumping up and down on the balls of the feet for 2-3 minutes every half hour, and 3) frequent walks up and down the aisles. Some evidence suggests that patients in high-risk demographics may benefit from a prophylactic anti-thrombotic – with low-weight molecular heparin (LMWH) likely being the best (but not so convenient) choice. A comparative study by Cesarone et al. published in <i style="mso-bidi-font-style: normal;">Angiology</i>, found that LMWH (given two to four hours pre-flight) was statistically superior (no DVTs in 82 subjects) to control (4/82) and aspirin alone (3/84). The current ACCP guidelines, however, do not recommend routine anti-thrombotic therapy, even for high-risk patients. Thus, it’s not likely that we will soon see “Leg Care Clinics” popping up in international terminals to offer a quick pre-flight shot of anti-DVT elixir.&nbsp; <o:p></o:p></span></div><div class="MsoNormal" style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><b>Dehydration: </b>“Drink some blasted sports drink.”</span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal" style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">It’s so easy to get dehydrated when traveling. There’s the dry air of a pressurized cabin, the mile-high altitude, and the stress and exertion of it all. With dehydration can come fatigue, grumpiness, a wicked headache, and (perhaps) an increased risk of DVT. So, what is the best way to stay hydrated? Common sense dictates that one avoids excessive alcohol and limit caffeinated beverages. But, what about drinking water? A 2002 JAMA study by Hamada et al. found that in-flight blood viscosity is better controlled with an electrolyte-enhanced beverage (110 mg of sodium and 30 mg of potassium per 8 oz) versus water alone. Perhaps your flight attendant should be serving Powerade rather than punchless coffee? Since that’s not likely to happen, bring packets of sports drink powder to mix with flight beverages. </span></div><div class="MsoNormal" style="margin: 0.1pt 0in 0.1pt 0.25in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal" style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">The dry air of a plane can parch external body parts too – like the nose, eyes, and skin. A bloody nose or corneal abrasion at 30,000 feet is not going to help anyone sit back and enjoy the flight. So, for at-risk folks, Vaseline for the nostrils and liquid tears for the eyes are great ideas. &nbsp;</span></div><div class="MsoNormal" style="margin: 0.1pt 0in 0.1pt 0.25in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal" style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">Dry skin can be a real issue too – and believe it or not this has been documented in the literature. A French study of eight volunteer long-haul airline passengers observed that in-flight skin capacitance decreased rapidly on both the face and forearms – with the most pronounced changes on the cheeks where it decreased by up to 37%. So, how about some aloe vera to go with that moist towelette?</span></div><div class="MsoNormal" style="margin: 0.1pt 0in 0.1pt 0.25in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoNormal" style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">The good news about the arid airline air is that it helps keep infectious organisms at bay. Thus, I wouldn’t worry too much about the cabin air circulation, but would, of course, worry about a febrile-appearing lady with a productive cough sitting right next to me. &nbsp;<o:p></o:p></span></div><div class="MsoNormal" style="margin: 0.1pt 0in; text-align: left;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span></div><div class="MsoListParagraph" style="text-align: left; text-indent: -0.25in;"><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">&nbsp; &nbsp; &nbsp; </span><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><b>Physical abuse from your surroundings:&nbsp;</b>“Avoid the pill-popping rugby player."</span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;</span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; I am well aware that carry-ons can tumble out of the overhead storage bins and that tall guys, like me, can bonk their heads, but accidental strangulation by a fellow passenger? That hadn’t occurred to me until several hours and two movies into our flight to Auckland. I sat crookedly next to my large and slumbering neighbor and resolved to fall asleep. Suddenly, though, a fire-siren-like scream rocketed through the cabin and a log-sized arm pinned my neck against the seat. Fortunately, the arm relaxed and I breathed again as my seatmate stood up, still screaming, and starting shaking the row in front of him. It all looked like an impromptu Maori war dance, the Haka. Luckily for me, and for the economy class as a whole, this hulking fella had some equally large friends with him – they jumped to his (and my) aide. Later, as they mercilessly ribbed him, I learned that he’d taken a double dose of Ambien, which had contributed to a very realistic nightmare. Why hadn’t my captain warned me about this.&nbsp;</span><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"> </span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">&nbsp; &nbsp;&nbsp; W</span><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">ell, there you go, a brief guide to keeping the skies health friendly. Oh, and please do not forget, systematic reviews have established that “tampering with, disabling or destroying the lavatory smoke detectors is prohibited by law.”</span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;"><br /></span><br /><span class="Apple-style-span" style="font-family: Times,'Times New Roman',serif;">&nbsp; &nbsp; &nbsp; Kia Ora (Cheers) from New Zealand.</span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-34723789665398236912012-01-28T12:01:00.000-08:002012-01-28T12:01:04.291-08:00From the I&D Archives: MorgellonsReposting this piece, from September 2010<br /><br /><br /><b>When illness is real and when it's "contested"</b><br /><br /> <style><!-- /* Font Definitions */ @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-fareast-font-family:Cambria; mso-hansi-font-family:Cambria; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br /><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Some years ago, a sinewy chap sought my help for an aggravating condition. This young man was convinced that microscopic bugs were crawling over and under his skin. You can imagine how horrible this creeping sensation would be and it had driven this guy to a frenzy of restlessness. His arms and legs were covered with excoriated sores and fingernail-induced streaks of scarlet. I inspected him from head to toe and couldn’t find evidence of insects or parasites. Then, as I silently puzzled the situation, he handed me a smudged envelope and asked me to carefully look inside. I removed a half dozen pieces of scotch tape, each holding a spattering of blackish specks. These specks, he declared, were the bugs that were tormenting him. I was doubtful, but nonetheless took a close look under a microscope. And while I didn't see signs of movement or anatomic structure, I wasn’t sure what the specks were or where they’d come from. After several minutes of debate, during which my patient wanted answers and I challenged his theory but failed to offer an alternative explanation, I noticed something. His fingernails were crusty. Along the nail bed and under the nail tips I noticed a blackish substance that looked like..."Are you a painter?" I asked him. Well, indeed he was, and it seemed clear to me that he was mistaking paint chips for parasites. But, he remained dubious. I thought he probably had a psychiatric condition called "delusional parasitosis;" he was certain that he had a treatable infestation.&nbsp; </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Years later, I wonder whether this patient and I were meeting at the intersection of a contested illness known (to some) as Morgellons syndrome. You may have heard of Morgellons before; it received some media attention around the time that the Centers for Disease Control and Prevention (CDC) announced they were partnering with Kaiser Permanente to study the syndrome. But more on that later. First, what exactly is a “contested illness”? </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">To define “contested illness,” let’s start with the concept of “medicalization” – the process by which aspects of the human situation are described and treated as medical conditions or illnesses. For example, bad breath is diagnosed as “halitosis”, and excessive sweating transforms into “hyperhidrosis.” Writes Dr. H. Gilbert Welch in an <i style="mso-bidi-font-style: normal;">LA Times</i>editorial: “Everyday experiences get turned into diseases, the definitions of what (and who) is normal get narrowed…we doctors feel increasingly compelled to look hard for things to be wrong in those who feel well.” Lately, the medicalization of society has been driven forward by several dynamics. These include the insatiable market and marketing of personal health and beauty products, and the Internet-enabled organizing capability of condition-specific support groups. When advocacy groups (arguing that they are suffering from a treatable medical condition) collide with skeptics within conventional medical institutions, the result is a “contested illness” such as Morgellons. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Nearly ten years ago, biologist Mary Leitao’s s two-year-old son developed a strange skin condition. He scratched at himself incessantly, creating sores that, upon close inspection, contained bundles of multi-colored fibers. The physicians Leitao consulted were either baffled or skeptical. Frustrated, Leitao set out to educate herself and, in the process, discovered that her son’s symptoms had been described before, as far back as the 1500s. In fact, she found a name for the problem in Thomas Browne's <i style="mso-bidi-font-style: normal;">A Letter to a Friend</i> (1690). The letter described a "distemper of children... called the Morgellons, wherein they critically break out with harsh hairs on their backs." Determined to help her son and others like him, Leitao created the Morgellons Research Foundation and its website to disseminate information about the condition. She was surprised when thousands of strangers with similar symptoms contacted her. Pretty soon, Mary Leitao’s frustration had transformed into an advocacy movement. But, experts in dermatology and psychiatry were not convinced – the overwhelming opinion from the medical community was that Morgellons was a variant of delusional parasitosis – a well-described psychiatric condition. According to dermatologist Norman Levine (quoted by Brian Fair in his recent article in <i style="mso-bidi-font-style: normal;">Sociology of Health &amp; Illness), </i>“[Morgellons] is not a mysterious disease…If you polled 10,000 dermatologists, everyone would agree [that Morgellons is Delusional Parasitosis].” </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">As Morgellons became more contested, the CDC, at the behest of some members of Congress, got involved. The CDC chose a middle ground in nomenclature – calling the condition “unexplained dermopathy,” and partnered with Kaiser Permanente to enroll and study patients suffering from “…symptoms including crawling, biting and stinging sensations; granules, threads or black speck-like materials on or beneath the skin; and/or skin lesions…”</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">And so here we are, several years later, waiting for the results and a peer-reviewed publication. The CDC website states that data collection for the study (which included skin samples from affected patients) is complete and under review by an expert panel. A press officer at the CDC confirmed this status (an inquiry to the Morgellons Research Foundation was not answered). </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Whatever the CDC reports, in my opinion the Morgellons story illuminates two distinct points. First, patients’ symptoms should always be taken seriously and symptomatic treatment offered if available. In the case of Morgellons-type symptoms, this means a thorough exam to look for an explanation and (at a minimum) recommendations to alleviate symptoms (such as hydrocolloid dressings, low-dose steroid creams and anti-itching medications). Second, the medicalization of the human condition contributes to the development of contested illnesses and this is not healthy. Is Morgellons the medicalization of a psychiatric condition or is it an unexplained illness? We don’t know. But while it is <i style="mso-bidi-font-style: normal;">clear</i> that those with an “unexplained dermopathy” do not feel well, it is also very <i style="mso-bidi-font-style: normal;">unclear </i>whether modern medicine is capable of a definitive solution to their problem. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Whatever the answer to the mystery of Morgellons, the dynamics that have made it a contested illness are not going away. I have a feeling that those dynamics will be bugging us for some time. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: &quot;Times New Roman&quot;;">**Dr. Ballard is not a part of the Kaiser Permanente team involved with Morgellons research. </span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-79265525311928977262012-01-28T11:57:00.000-08:002012-01-28T11:57:10.265-08:00CDC Study on Morgellons Published<br />After years of waiting, this study on Morgellons (aka 'Unexplaine Dermopathy") has been released.<br /><br />Click <a href="http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0029908" target="_blank">here</a> for the full text and see below for the authors conclusions<br /><br />"This unexplained dermopathy was rare among this population of Northern California residents, but associated with significantly reduced health-related quality of life. No common underlying medical condition or infectious source was identified, similar to more commonly recognized conditions such as delusional infestation."<br /><br /><br /> <br />DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-53504726995195860922012-01-28T11:52:00.000-08:002012-01-28T11:52:52.395-08:00THE Iceman Warmeth<style><!-- /* Font Definitions */ @font-face {font-family:Arial; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {mso-style-noshow:yes; color:purple; text-decoration:underline; text-underline:single;} span.apple-converted-space {mso-style-name:apple-converted-space;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br /><div class="MsoNormal">&nbsp; </div><div class="MsoNormal">The mind has incredible powers – it can create illusions out of thin air and hear voices that don’t exist. It can modify the body’s response to pain, disease and stress. It can eliminate symptoms simply through the power of belief. The mind is powerful, but is it capable of regulating bodily temperature? Wim Hof of the Netherlands, known to some as the Iceman, would have us believe that it is. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">When I first learned of Wim from my neighborhood YMCA Zennie, I was quite skeptical. I remained unconvinced after skimming through his recently released and quite disjointed book, <i style="mso-bidi-font-style: normal;">Becoming the Iceman</i>. But as I have researched the Web (and by the Web I mean YouTube) and the medical literature, my skepticism has softened greatly. More on that in a moment – but first – about the Iceman. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Wim Hof is fifty-two years old and, like many of us middle-agers, he has flat and thinning hair and shorts that ride higher than warranted. But unlike most others (middle-age or not) on the planet, he can mute his body’s response to extremely cold temperature. If you don’t believe me, pull up some of the videos – they are remarkable. But for those who might be experiencing a Comcast moment without connectivity (I’m not the only one, am I?), let me expound. The Iceman, whose stated profession is “world record breaker,” has completed each of the following cold hard tricks: 1) stood fully immersed in seven hundred pounds ice for one hour and forty-four minutes, 2) hiked to the top of <span lang="EN" style="mso-ansi-language: EN; mso-bidi-font-family: Arial; mso-bidi-font-size: 9.5pt;"><a href="http://en.wikipedia.org/wiki/Mount_Kilimanjaro" title="Mount Kilimanjaro"><span style="color: windowtext; text-decoration: none; text-underline: none;">Mount Kilimanjaro</span></a><span class="apple-converted-space">&nbsp;(19,340 feet) in two days </span>wearing only shorts, and 3) completed a full marathon in similar attire in temperatures averaging about -4 degrees Farenheit.<span style="mso-spacerun: yes;">&nbsp; </span></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal">I think we can all agree that these are feats that are not for the average weekend warrior and may be unnecessarily masochistic. But, Wim finds them therapeutic. “Cold is a warm friend,” he says. And yes, cold is nice – in ice cream and popsicles – but how does someone stay emerged in ice for almost two hours without damage? Scientists who have studied Wim’s response to cold temperatures are amazed. Says one in a TED video “He is a physiological mystery.” Incredibly, Wim can maintain a stable core body temperature for nearly an hour while submerged in ice – a trick that you would <i style="mso-bidi-font-style: normal;">absolutely </i>not want to try at home. And, his heart rate and breathing also stay stable – once again not the expected response. So, something about the Iceman is different. Perhaps it is his lifetime of acclimatization to cold temperatures or maybe it is because he is a genetic freak. Or maybe, just maybe, it is because he is an alien from the planet Neptune. Or, perhaps, as Wim asserts, it is because his mind has mastered his body through meditation. Yes, Wim has a meditative technique, one that is onerously documented in his book. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">It’s called Tummo meditation, and it is an ancient practice of Buddhist Monks. Thirty years ago, a study by Benson et al, published in <i style="mso-bidi-font-style: normal;">Nature </i>reported the bodily responses of Indo-Tibetan Yogis practicing this technique – demonstrating remarkable changes in the temperature of their fingers and toes (up to 17 degrees Farenheit) in a cold environment. Later, the same team produced videos of Tibetian monks drying frigid wet sheets with their own body heat. So, it seems possible to alter the brain’s automatic nervous system (autonomic nervous system) through merely the focus of the mind. How this works, from a physiology standpoint, remains a mystery. We do know that it is not unprecedented in the animal kingdom – many animals, including snails and bees, can regulate body temperature. This fact suggests that an ancient area of the brain – such as the hypothalamus – is involved. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Dr. Andrew Newberg, Director of Research at the Myrna Brind Center of Integrative Medicine at Thomas Jefferson University, and the author of a study of cerebral blood flow during meditation, summarizes the science of the question like so... </div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-bidi-font-size: 11.0pt;">“…it is known that meditation, including Tummo, can have profound effects on the autonomic nervous system that regulates body metabolism, temperature, etc.&nbsp; So while I am not sure if there has been any systematic study other than some old studies, it is reasonable to postulate that people can regulate body temperature and metabolism through meditation practices. Further, it is not just increased metabolism, but sometimes a decreased metabolism that allows for a conservation of energy in the body. This might allow the body to function at a broader range of temperatures. However, a lot of this is speculation.”</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="mso-bidi-font-size: 11.0pt;">And what also is speculation is how the Iceman can effectively practice the Tummo technique while in motion – such as when attempting to climb Mt. Everest in shorts (he made it to almost 25,000 feet). What is not in doubt, however, is the power of the mind and the wonderful irony that for many of us what often limits the power of mind is its preference for the status quo. You might say that the greatest impediment to the mind is the mind itself.<span style="mso-spacerun: yes;">&nbsp;&nbsp; </span></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal">&nbsp;To watch Wim Hof in cold hard action, click <a href="http://www.youtube.com/watch?v=L9Cgaa8U4eY" target="_blank">here </a></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-63378183252823790442011-12-05T08:35:00.000-08:002011-12-05T08:35:10.123-08:00Happy and Healthy Birthday<style><!-- /* Font Definitions */ @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {mso-style-noshow:yes; color:purple; text-decoration:underline; text-underline:single;} p {mso-margin-top-alt:auto; margin-right:0in; mso-margin-bottom-alt:auto; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br />Today is a very important day in history. You may wonder why. Is it because it’s the day Prohibition was repealed in 1933? No, although I’ll happily toast Prohibition’s prohibition, that’s not what makes December 5<sup>th</sup> special. Nor is it because on December 5<sup>th</sup>, 1927, the first worldwide <span style="font-family: Cambria;">roller canary singing championship was held in Manitoba</span> (although that is fascinatingly esoteric.) Actually the 5<sup>th</sup> of December is of vital importance because it is the day on which my wife Angela was born. And I would put myself at great risk if I were to forget this. As Robert Frost once wrote, “A diplomat is a man who always remembers a woman's birthday but never remembers her age.” So, to keep healthy, I follow Frost’s advice as well as that of my brother, who often reminds me, “happy wife, happy life.” <br />Sadly, for many adults (my wife excluded) birthdays aren’t associated with happiness or wellness. Sure, “making” it to the next birthday can be a big event, especially if it is year 100, but too often birthdays herald unhealthy thoughts and behavior. In these cases, people agree with John Glenn that there is “still no cure for the common birthday.” In fact, studies show that the reality and awareness of one’s own mortality, (scientists call this “mortality salience”) may not only lead to the “birthday blues,” but also increase mortality risk. For example, a study of former major league baseball players, now dead, found they were more likely to die on their birthday than on any other day. Similarly, an investigation published in <i style="mso-bidi-font-style: normal;">Neurology </i>in 2006 reported that strokes and heart attacks are more common on birthdays. The researchers speculated that associated stress was to blame. Yet another study looked at suicides committed on one’s own date of birth – finding a slightly increased risk – especially among those over the age of 35.<br />Could the birthday blues be a self-fulfilling prophecy? One fulfilled like so: 1) someone is convinced something bad will happen on his birthday (for example, one might feel superstitious upon reaching the age at which one’s mother or father died); 2) a physiological stress response ensues; 3) blood pressure rises and arteries constrict, resulting in; 4) a vascular event (such as a heart attack); and 5) the birthday celebrant now <i style="mso-bidi-font-style: normal;">actually</i> is more likely to die. Or, in the worst-case scenario, someone might actuate the birthday stress in the extreme by taking her own life. Pretty depressing. Depressing enough to convince me that the American Adult Birthday needs an extreme health makeover. <br />Recognizing that birthdays will never again be like they were when we were kids – events giddily anticipated for months in advance – I think there is a way to make them less deadly for adults. So, in honor of my wife’s birthday (funny, I don’t seem to recall how old she’ll be this year), I’d like to propose that the birthday take a turn for the happy and healthy. Yes, you can still have the cake and an extra drink or two, but how about also making several birthday declarations? Let’s call these “candlelight promises.” Try stick to just a handful of them (save the rest for New Years) and your birthday can become a healthy turning point. Looking for ideas?<br />*Plan and execute one big trip or event each year – something that you have always wanted to do but haven’t gotten around to. The planning itself will keep you focused and give you something great to look forward to. As Lincoln wrote, “<a href="http://thinkexist.com/quotation/and_in_the_end-it-s_not_the_years_in_your_life/10059.html">And in the end, it's not the years in your life that count. It's the life in your years.</a>” By choosing the life that excites us, we may actually stick around longer.<span style="mso-spacerun: yes;">&nbsp; </span><br /><div class="MsoNormal">*Pick up one new sport or hobby and give it a whirl. Doesn’t have to be anything extreme – taking up technical mountain climbing to celebrate your 90th may not be too wise – but what about painting, sculpture, or Yahtzee? </div>*Commit to one new healthy habit. You may like Lucille Ball’s suggestions; “<a href="http://thinkexist.com/quotation/the_secret_to_staying_young_is_to_live_honestly/166270.html">The secret to staying young is to live honestly, eat slowly, and lie about your age.</a>” Or you may prefer mine, which is to floss twice daily.<br /><div class="MsoNormal">So there you go; hopefully this gives you something new for a day that may have lost its luster. And to my wife, I wish you a happy <i style="mso-bidi-font-style: normal;">and </i>healthy birthday. </div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-37941176972201910682011-11-28T20:21:00.001-08:002011-11-28T20:21:16.874-08:00Bicycle Helmets are for Everyone (Marin IJ)<style><!-- /* Font Definitions */ @font-face {font-family:Arial; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Times; panose-1:2 0 5 0 0 0 0 0 0 0; mso-font-charset:77; mso-generic-font-family:roman; mso-font-format:other; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:Cambria; mso-bidi-font-family:"Times New Roman";} a:link, span.MsoHyperlink {color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {mso-style-noshow:yes; color:purple; text-decoration:underline; text-underline:single;} p {margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; mso-pagination:widow-orphan; font-size:10.0pt; font-family:Times; mso-fareast-font-family:Cambria; mso-bidi-font-family:Times;} span.apple-converted-space {mso-style-name:apple-converted-space;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br /><div style="background: white; margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Cambria; font-size: 12.0pt; mso-bidi-font-family: Cambria;">Some time ago, I received a call from a friend of mine named Ecke. A retired Ross Valley Fire Captain, Ecke was wondering if he’d seen me biking down Butterfield Road earlier that day. Why yes, I said, that was me. “I couldn’t help but notice,” he rejoined, “that you weren’t wearing a bicycle helmet.” He was absolutely right, I hadn’t been. “Here you are,” Ecke continued, “talking big in the paper about safety and stuff and really you’re just a phoney-baloney.” </span></div><div style="background: white; margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><br /></div><div style="background: white; margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Cambria; font-size: 12.0pt; mso-bidi-font-family: Cambria;">Thankfully, Ecke is just about the most good-natured guy I know, and he was just poking fun at me. But nonetheless, I felt a wee bit ashamed. Because I do know better; head injuries are by far the leading cause of death and disability among cyclists <i style="mso-bidi-font-style: normal;">and </i>helmets have repeatedly been proven a powerful preventive device. For example, a 1991 study from the<span class="apple-converted-space">&nbsp;</span><span style="border: none windowtext 1.0pt; mso-border-alt: none windowtext 0in; padding: 0in;">U.C. Berkeley Institute of Transportation Studies</span><span class="apple-converted-space">&nbsp;<span style="color: black;">found that out of </span></span><span style="color: black;">1,430 bicycle-related head injuries, 1,216 (85 percent) could have been prevented or mitigated by helmet use, with a potential savings (in hospital charges alone) of $16.7 million. Because of evidence like this,</span> the state of California mandated helmet use for children under the age of 18 back in 1993. Similarly convinced of helmets’ worth, the city of Berkeley recently <i>gave away</i> nearly 1,500 of them.</span></div><div style="background: white; margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><br /></div><div style="background: white; margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><span style="font-family: Cambria; font-size: 12.0pt; mso-bidi-font-family: Cambria;">The helmet give-away (which ended last month) was paired with instruction on safe biking practice and was part of a year-long injury prevention program sponsored by the City of Berkeley and the California Office of Traffic Safety.</span><span style="font-family: Cambria; font-size: 12.0pt;"> Kate Clayton, MPH, Chief of the Health Promotion Section for Berkeley Public Health, explains; “</span><span style="color: black; font-family: Cambria; font-size: 12.0pt; mso-bidi-font-family: Arial; mso-fareast-font-family: &quot;Times New Roman&quot;;">Recognizing that helmets are an important strategy for reducing morbidity and mortality when collisions do occur,” she said, the program “focused on youth and their families in low-income neighborhoods with relatively poorer health outcomes compared to the rest of the city.” </span><span style="font-family: Cambria; font-size: 12.0pt; mso-bidi-font-family: Cambria;"></span></div><div style="background: white; margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><br /></div><div class="MsoNormal" style="margin-bottom: .05pt; margin-left: 0in; margin-right: 0in; margin-top: .05pt;"><span style="font-family: Cambria; mso-bidi-font-family: Cambria;">This seems like a noble endeavor, but can giveaway programs really make much of a difference in helmet compliance? Two decades ago, a seminal study in Seattle demonstrated that the barriers to bike helmet use go beyond cost and include knowledge and perception. In the Seattle area (and elsewhere as well, I’m sure), a significant factor behind children’s failure to don helmets was their concern that “wearing a helmet would result in their being viewed as ‘nerds.’” Thus, if helmet use is to be encouraged (without the strong arm of the law) a multi-pronged approach – one that includes education and culture change – offers the best chance at lasting success. This observation was borne out by a meta-analysis (a study reviewing multiple prior studies) published in <i>Injury Prevention </i><span style="mso-bidi-font-style: italic;">in 2006<i>.</i></span> The authors re-analyzed data from multiple publications on the topic of encouraging bike helmet use without legal interventions, and reported that the most effective tactics were community-based efforts to give away free (rather than subsidized) helmets. </span></div><div class="MsoNormal" style="margin-bottom: .05pt; margin-left: 0in; margin-right: 0in; margin-top: .05pt;"><br /></div><div class="MsoNormal" style="margin-bottom: .05pt; margin-left: 0in; margin-right: 0in; margin-top: .05pt;"><span style="font-family: Cambria; mso-bidi-font-family: Cambria;">Promising, but what about also giving helmets an image makeover – re-inventing them to exude style and fashion? Impossible? Probably. But there are brands that are bravely trying to market the hipster helmet.<u> </u><a href="http://www.coolhunting.com/archives/2008/08/yakkay_bicycle.php"><span style="color: windowtext; text-decoration: none; text-underline: none;">Yakkay</span></a>, (</span><span style="font-family: Cambria;">http://www.yakkay.com) </span><span style="font-family: Cambria; mso-bidi-font-family: Cambria;">for example, uses the tagline “brainwear for smart people” and makes helmets that look like hats with chin strap accessories.<span style="mso-spacerun: yes;">&nbsp; </span>And while they don’t carry a 49ers lid, and their style is not quite Supra-esque, the checkered Cambridge design does make a certain statement. </span></div><div class="MsoNormal" style="margin-bottom: .05pt; margin-left: 0in; margin-right: 0in; margin-top: .05pt;"><br /></div><div class="MsoNormal" style="margin-bottom: .05pt; margin-left: 0in; margin-right: 0in; margin-top: .05pt;"><span style="font-family: Cambria; mso-bidi-font-family: Cambria;">Fortunately, even though most helmets remain style-deficient, here in Marin a large percentage of our cyclist population is cool with wearing them. In fact, on weekends, the streets of Fairfax (where I live) are practically teeming with helmeted cyclists. Yet, there is still room for improvement. Some people who reflexively click their seatbelts every time they get in the car somehow have a blind spot for head protection. For example, I routinely see parents biking down busy streets to school with their kids, and the child is wearing a helmet, while mom and/or dad is not. I’ve obviously been guilty of something like this too. Sometimes we forget (that’s my excuse!), sometimes items are misplaced, and sometimes we just don’t think there is much of a risk. But, parents need to remember three things: 1) children model their behavior, 2) biking without a helmet is indeed taking a significant risk, and 3) a traumatic brain injury is an awful thing to have. </span></div><div class="MsoNormal" style="margin-bottom: .05pt; margin-left: 0in; margin-right: 0in; margin-top: .05pt;"><br /></div><div class="MsoNormal" style="margin-bottom: .05pt; margin-left: 0in; margin-right: 0in; margin-top: .05pt;"><span style="font-family: Cambria;">My friend </span><span style="font-family: Cambria; mso-bidi-font-family: Cambria;">Ecke has a favorite saying: </span><span style="font-family: Cambria;">“Yesterday’s history, tomorrow’s a mystery, today’s a gift. That’s why they call it the present.” If you think it’s no big deal to forego your helmet when biking, remember today IS a gift, protect it. Use a helmet to safeguard your head and your reputation. </span></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-13517830980791651392011-10-27T20:34:00.001-07:002011-10-27T20:34:07.301-07:00Healthy Eats<style><!-- /* Font Definitions */ @font-face {font-family:"Courier New"; panose-1:2 7 3 9 2 2 5 2 4 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Times; panose-1:2 0 5 0 0 0 0 0 0 0; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Wingdings; panose-1:5 2 1 2 1 8 4 8 7 8; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 0 65536 0 -2147483648 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:"Lucida Grande"; 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mso-fareast-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @list l5 {mso-list-id:1963876138; mso-list-type:hybrid; mso-list-template-ids:1386622226 67698689 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l5:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:none; mso-level-number-position:left; text-indent:-.25in; font-family:Symbol;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --></style> <br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Times;">You are what you eat. I’m guessing you’ve heard this cliche before. But have you thought about what it means and whether it’s true? Surely, “You are what you eat,” doesn’t mean that later today I’ll morph into a frosted doughnut with Halloween sprinkles. What it does mean is that my body is built, mostly, on nutrients I consume. There are, of course, exceptions – women are born with all of the (non-surrogate) eggs they will have for their lives and medical devices do not use diet to sustain themselves. Tooth enamel and cerebral cortex neurons stay constant but, other than that, our bodies undergo constant turnover. And, as we all know, the substrate for that turnover is what we eat (so, if you had a turnover for breakfast, that turnover is used for turnover). And even those things in our bodies that are not directly the result of diet are affected by it. Your teeth, for example, are highly sensitive to the food you eat and its sugar content. So, food matters – and food quality affects health. But, eating well is expensive, right? </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal" style="mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="font-family: Times;">Consider a recently published University of Washington study that examined the cost of eating a diet compliant with the federal </span><i style="mso-bidi-font-style: normal;"><span style="font-family: AdvOT3f82cb7c; mso-bidi-font-family: AdvOT3f82cb7c; mso-bidi-font-size: 9.5pt;">Dietary Guidelines for Americans, 2010</span></i><span style="font-family: Times;"> – which recommends increased dietary quantities of vitamin D, calcium, dietary fiber and potassium and less sugar and saturated fat. Using a survey to assess eating habits and then tallying retail prices at Seattle-area food suppliers, the study team tabulated the estimated dollars needed to get enough of some key nutrients, such as potassium. Based in part on the fact that such nutrients are plentiful in fresh produce and hard to find elsewhere, the researchers reported that meeting the guidelines would add to food costs. In fact, for one nutrient (potassium), an additional $380 was needed per person per year to meet recommended guidelines. On the other hand, for every 1% increase in dietary calories obtained from sugar and saturated fat, study subjects saved approximately $26 (sugar) to $102 (saturated fat) per person per year. Based on these findings, the authors concluded </span><span style="font-family: Times; mso-bidi-font-family: &quot;AdvOT17a2fb79\.B&quot;; mso-bidi-font-size: 11.0pt;">that,</span><span style="font-family: Times;"> </span><span style="font-family: Times; mso-bidi-font-family: &quot;AdvOT17a2fb79\.B&quot;; mso-bidi-font-size: 11.0pt;">“Improving the American diet will require additional guidance for</span><span style="font-family: Times;"> </span><span style="font-family: Times; mso-bidi-font-family: &quot;AdvOT17a2fb79\.B&quot;; mso-bidi-font-size: 11.0pt;">consumers, especially those with little budget flexibility, and new policies to increase the availability and reduce the cost of healthful foods.”</span><span style="font-family: AdvOT3f82cb7c; font-size: 9.5pt; mso-bidi-font-family: AdvOT3f82cb7c;"></span></div><div style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt;"><br /></div><div class="MsoNormal"><span style="font-family: Times;">This study certainly has limitations in terms of its scope and methods (including the fact that the calories and costs were estimated rather than directly observed), but it nonetheless supports the conventional wisdom that you have to be rich to eat a healthy diet. I argue, however, (and I’m not alone in this) that conventional wisdom is simply not true on this point. It is, of course, a lot easier to be a healthy eater if you have a fat wallet, but it’s certainly possible without one. And while I agree with the basic tenet of AB 581(declaring access to healthy food items a basic human right), I don’t think this issue should be left to legislation alone. For example, here is a quick recipe of tips for economic and nutritious eating. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><i style="mso-bidi-font-style: normal;"><u><span style="font-family: Times;">Recipe for Eating Well on a Tight Budget. </span></u></i></div><div class="MsoNormal"><br /></div><div class="MsoListParagraphCxSpFirst" style="mso-list: l3 level1 lfo6; text-indent: -.25in;"><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">Mix the following into your routine</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level2 lfo6; text-indent: -.25in;"><span style="font-family: &quot;Courier New&quot;; mso-bidi-font-family: &quot;Courier New&quot;; mso-fareast-font-family: &quot;Courier New&quot;;"><span style="mso-list: Ignore;">o<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">Two parts buying local, fresh and in-season when possible.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level2 lfo6; text-indent: -.25in;"><span style="font-family: &quot;Courier New&quot;; mso-bidi-font-family: &quot;Courier New&quot;; mso-fareast-font-family: &quot;Courier New&quot;;"><span style="mso-list: Ignore;">o<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">Three cups planning nutritious meals that can be re-served another night.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level2 lfo6; text-indent: -.25in;"><span style="font-family: &quot;Courier New&quot;; mso-bidi-font-family: &quot;Courier New&quot;; mso-fareast-font-family: &quot;Courier New&quot;;"><span style="mso-list: Ignore;">o<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">One part frequent thick and hearty soups (these will cut back the urge to splurge).</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level2 lfo6; text-indent: -.25in;"><span style="font-family: &quot;Courier New&quot;; mso-bidi-font-family: &quot;Courier New&quot;; mso-fareast-font-family: &quot;Courier New&quot;;"><span style="mso-list: Ignore;">o<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">Three carts of buying generic and in bulk and freezing perishables.</span></div><div class="MsoListParagraphCxSpMiddle" style="margin-left: 1.0in; mso-add-space: auto; mso-list: l3 level2 lfo6; text-indent: -.25in;"><span style="font-family: &quot;Courier New&quot;; mso-bidi-font-family: &quot;Courier New&quot;; mso-fareast-font-family: &quot;Courier New&quot;;"><span style="mso-list: Ignore;">o<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">Six tablespoons of reading food labels. You’ll be shocked at all the added sodium. </span></div><div class="MsoListParagraphCxSpMiddle" style="mso-list: l3 level1 lfo6; text-indent: -.25in;"><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">Cook this mixture slowly in a reduction sauce dedicated to cutting back on unrefined sugar, saturated fat and expensive and unnecessary vitamin supplements. </span></div><div class="MsoListParagraphCxSpLast" style="mso-list: l3 level1 lfo6; text-indent: -.25in;"><span style="font-family: Symbol; mso-bidi-font-family: Symbol; mso-fareast-font-family: Symbol;"><span style="mso-list: Ignore;">·<span style="font: 7.0pt &quot;Times New Roman&quot;;">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </span></span></span><span style="font-family: Times;">Finish with three thimbles of nutrition education.</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Times;">It is in the finishing that the most enduring benefit will be found – for you and your family. In particular, we could be doing a much better job of teaching our children about food and nutrients and creating a life-long appreciation for their importance. As a father who delivers sprinkled doughnuts home on a bi-weekly basis, I am likely more delinquent on this point than many in Marin. So, for parents like me a great place to start the schooling sauté is at the North Bay Discovery Day. On November 5<sup>th</sup>, in an event sponsored by The Buck Institute, over 50 exhibitors will gather at Infineon Raceway, all tasked with helping to make science fun and accessible for kids. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Times;">Among the exhibitors is accomplished chef Ted Smith, founder of <span style="color: black;">Kids Cooking for Life (KCL) which is a community program that focuses on educating children on food, cooking and (big bonus!) table manners. </span></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="color: black; font-family: Times;">The KCL exhibit (in partnership with Kaiser Permanente) on Discovery Day is called a “Whole Grain Adventure” and will feature fun and games (including a Fiber Race) and deliver the </span><span style="font-family: Times; mso-bidi-font-size: 14.0pt;">message “that whole grains (and the fiber they contain) are an essential ingredient of a healthful diet.”</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Times; mso-bidi-font-size: 14.0pt;">Ted Smith writes, “</span><span style="color: black; font-family: Times;">I strongly believe that you don't have to be wealthy to eat healthy.&nbsp;What I’ve learned as an owner-operator of restaurants in Chicago for over 23 years (and having served over 18 million customers) is this: fruits and vegetables are a lot cheaper than meat, seafood and poultry! And fruit and vegetables is where you find healthy eating.” </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="color: black; font-family: Times;">And don’t worry, a diet rich in produce will not turn you into a turnip. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Times;">For more info about Discover Day check out </span></div><div class="MsoNormal"><span style="font-family: Times;">http://www.buckinstitute.org/discoveryday</span></div><div class="MsoNormal"><br /></div><div class="MsoNormal" style="margin-left: .25in;"><br /></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-90228061666970641232011-10-03T07:43:00.001-07:002011-10-03T07:43:16.887-07:00The Good, The Bad, The Ugly (Marin IJ)<style><!-- /* Font Definitions */ @font-face {font-family:Arial; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:auto; 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margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br /><div class="MsoNormal"><span style="mso-bidi-font-size: 10.0pt;">You may have noticed that vaccines are back in the news. In fact, the last few weeks have brought several related stories, which as a vaccine advocate, I would categorize as the <i style="mso-bidi-font-style: normal;">Good</i>, the <i style="mso-bidi-font-style: normal;">Bad</i> and the <i style="mso-bidi-font-style: normal;">Ugly</i> (yes, vaccines and Clint Eastwood movies do have something in common!) These developments can be summarized as 1) Good; rotavirus vaccine benefits children and public health, 2) Bad; pertussis (whooping cough) vaccine wears off sooner than previously thought (after about three years) and 3) Ugly; the </span>Human papillomavirus<span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;"> (</span><span style="mso-bidi-font-size: 10.0pt;">HPV) vaccine was blindsided by hearsay from a U.S. presidential candidate. More plot details below…</span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-size: 10.0pt;">Good: Rotavirus vaccine decreases health costs</span></b></div><div class="MsoNormal"><span style="mso-bidi-font-size: 10.0pt;">Have you heard of rotavirus? As a medical student studying for the boards, I had trouble remembering what type of infection this bug caused until I learned the </span><span class="st">mnemonic</span><span style="mso-bidi-font-size: 10.0pt;"> R-O-T-A, which stands for “right out the a@*&amp;#.” That pretty much sums it up. Rotavirus is a leading cause of diarrhea, especially in children under the age of five. Tens of thousands of kids visit emergency departments each year because of rotavirus (which can cause life-threatening dehydration), and thousands more will require hospitalization for re-hydration. According to the CDC, </span>just five years ago, rotavirus was responsible (annually) for approximately 55,000 to 70,000 hospitalizations and 20 to 60 deaths among young children.<span style="mso-bidi-font-size: 10.0pt;"> Even in mild cases, rotavirus is a bummer for everyone involved, except, that is, for the diaper industry. </span></div><div class="MsoNormal"><span style="mso-bidi-font-size: 10.0pt;">The good news is that there are now two licensed vaccines against rotavirus (<span style="mso-field-code: &quot;HYPERLINK \0022http\:\/\/www\.medilexicon\.com\/drugs\/rotateq\.php\0022 \\t \0022_blank\0022&quot;;"><u>RotaTeq</u></span> and <span style="mso-field-code: &quot;HYPERLINK \0022http\:\/\/www\.medilexicon\.com\/drugs\/rotarix\.php\0022 \\t \0022_blank\0022&quot;;"><u>Rotarix</u></span>) and recent evidence suggests that they are working well. In the September 22nd issue of the <i style="mso-bidi-font-style: normal;">New England Journal of Medicine (NEJM)</i>, researchers from the CDC reported the results of a 2001-2009 study comparing pre- and post-vaccination outcomes. Their results suggest that the vaccine (first widely available in 2007) resulted in an approximately one-half reduction in diarrhea-related ED visits and hospitalizations. Furthermore, the researchers calculated that the vaccine had likely prevented over 20,000 hospitalizations a year since 2007, resulting in a health care cost savings of over $90 million a year. I think you’ll agree; that’s a public health benefit we shouldn’t be flushing away. </span></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-size: 10.0pt;">Bad (well, not totally bad): Pertussis vaccine wears off earlier than thought</span></b></div><div class="MsoNormal">Hopefully by now everyone knows that we are in the midst of a pertussis (whooping cough) epidemic – one in which (quite regrettably) Marin County has led the way. This epidemic is multi-factorial – it is due in part to natural disease fluctuation, but also related to significant rates of personal belief exemptions (PBEs) for vaccines and waning immunity in older kids and adults. We have suspected for some time that the typical schedule of acellular pertussis vaccination (in older kids and adults) does not provide adequate protection and very recent (and still unpublished) evidence from the 2010 pertussis outbreak seems to confirm this. Dr. David Witt (infectious disease) and Dr. Paul Katz (pediatrics) from San Rafael Kaiser Permanente recently studied over 15,000 kids under the age of 18 in Marin County and identified 132 confirmed cases of pertussis. Their preliminary results, presented two weeks ago at the <span style="mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">American Society for Microbiology in Chicago, suggest several important trends; 1) vaccinated children (age 2-18) are less likely to get whooping cough than unvaccinated ones, 2) younger children (age 2-7) who are vaccinated are well protected against disease and 3) older kids (with a peak around age 12), even if vaccinated, are very susceptible. In fact, the risk for 12-year olds is approximately ten times higher than for 2-7 year olds. This, then, seems to be good justification for the idea of a pertussis booster shot (as now required by state law AB 354) for 7<sup>th</sup>-12<sup>th</sup> graders. Fortunately, and this is where the bad news is not really so bad, Marin County seems to be doing very well with these boosters. According to public health officer, Dr. Jason Eberhart-Phillips, “</span>We are nearly there to full compliance in Marin at this time. Local education officials understand and value the health and well-being of their students!&nbsp;“</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial;">Ugly: The HPV vaccine flap</span></b><b style="mso-bidi-font-weight: normal;"><span style="mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;"></span></b></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Genital warts are not a pleasant topic. Especially when you consider that the causative virus (HPV) is a major risk factor for cervical cancer. Cervical cancer is nasty, even for cancer, and it kills young women. If you have any doubt about how horrible this cancer can be, consider this description of metastatic disease from <i style="mso-bidi-font-style: normal;">The Immortal life of Henrietta Lacks</i> by Rebecca Skloot… “Henrietta’s body was almost entirely taken over by tumors. They’d grown on her diaphragm, her bladder and her lungs. They’d blocked her intestines and made her belly swell like it was six months pregnant.” Fortunately, HPV immunization offers significant protection (70% or so) against cervical cancer in addition to genital warts. But despite its well-documented safety (over 35 million doses given worldwide), the context of the topic (teenagers having sex) has fueled some political pushback. </span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">On September 13, the day after a GOP presidential candidates debate, Michelle Bachmann claimed on several media outlets that the HPV vaccine was hazardous and could cause “mental retardation.” Later, Bachman told Matt Lauer on the “Today” show that the HPV vaccine has "very dangerous consequences" and that it puts "little children's lives at risk." As it turns out, these statements were based, <u>not</u> on fact, but on a single anecdotal account from a woman who had talked to Bachmann at a campaign event. This sort of <span style="mso-spacerun: yes;">&nbsp;&nbsp;</span>“a person I knew had a…” approach to public health is not healthy. In fact, this tact by a public figure was so egregious that Dr. Arthur Caplan of the </span><em>University</em><span class="st"> of </span><em>Pennsylvania Center for Bioethics</em><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">, challenged Bachmann – offering her $10,000 of his own money (to be given to a charity of her choice) if she could, in Caplan’s words, “produce a person within a week who had been made ‘retarded’ by the HPV vaccine, and if that claim could be verified by three doctors.” It’s been several weeks now and Caplan’s challenge remains unanswered. I asked Dr. Caplan to summarize his opinion of the situation: </span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal"><span style="font-family: Times; mso-bidi-font-size: 10.0pt;">He says, “Bachmann decided to base her campaign on an anti-vaccination platform. To do so she had to claim that vaccines like the HPV vaccine to prevent cervical cancer are dangerous. &nbsp;Her willingness to throw away women's lives for political gain is not only unworthy of a Presidential candidate it is morally despicable.”</span></div><div class="MsoNormal"><span style="font-family: Times; mso-bidi-font-size: 10.0pt;">“As a recent study in NEJM on vaccines against rotavirus demonstrated,” Caplan continues, “vaccines remain our best response to lethal and disabling diseases in children and adults. By continuing to allow politicians, celebrities and crackpots to spew utter nonsense about vaccine dangers the medical, scientific and media communities are complicit in compromising the health of the public both in the U.S. and worldwide. <span style="mso-spacerun: yes;">&nbsp;</span>Vaccines do have risks as do every other health intervention from alternative medicine, to aspirin, to anesthesia. &nbsp;But, vaccines are among the safest and most effective tools we have to fight dread diseases. &nbsp;The public should know that and hopefully my challenge to Bachmann will help make that happen.”</span></div><div class="MsoNormal"><span style="font-family: Times; mso-bidi-font-size: 10.0pt;">Ugly situation indeed, but if it results in a better understanding of vaccines, including their minimal risk in the face of major benefits, it will lead to a prettier picture of public health. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-40343231667508486032011-09-21T09:46:00.000-07:002011-09-21T09:46:27.875-07:00Michelle Bachmann's Assault on Public Health (Art Caplan)<div class="entryBody"><br /><div class="hdr_border"> <div class="title_hdr"> Michele, My Warning Bell about Vaccine Fear-Mongering </div></div><div class="blog"> <span class="tags">Public Health</span> <div class="meta"><strong>Arthur Caplan</strong>, 09/20/2011</div></div><br />Read more: <a href="http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5543&amp;blogid=140#ixzz1YbeEpERW" style="color: #003399;">http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5543&amp;blogid=140#ixzz1YbeEpERW</a><br /><br />Greg Kaebnick, the editor of the <i>Hastings Center Report</i> (and, full disclosure, a former student of mine!) kindly invited me to offer some comments on my decision to publicly challenge Congresswoman and presidential candidate Michele Bachmann’s comments on the safety of the HPV vaccine. I am happy to do so. It lets me tell a story that might be of interest to the bioethics community and to offer a few comments about my own thinking about the public work in which some bioethicists engage.<br />Yesterday, Bachmann abandoned her claim that the vaccine was dangerous, saying she was only repeating a story she had been told. Of course, rumor-mongering is hardly a defense. Moreover, she has apparently decided to make an antivaccination stance a key part of her campaign to dislodge Texas Governor Rick Perry from his position as the GOP’s leading presidential candidate.<br />In running against vaccines, Bachmann is willing to dissemble and lie about vaccine safety to try and score political points. She is also apparently willing to sacrifice the lives of young women in the U.S. and around the world to cancer, as well as others who may die of whooping cough or flu to her political ambition by impugning the safety and efficacy of vaccines and vaccine mandates. This stance should not only disqualify her from selection as the GOP candidate for any national office, but it should also lead her Minnesota constituents to think about whether she belongs in Congress at all.<br /><h3>The HPV flap to date<br /></h3>&nbsp;On Tuesday, September 13, the day after the GOP presidential candidates debate, Bachmann claimed on various media outlets that the HPV vaccine was dangerous and could cause “mental retardation”. Bachman told Matt Lauer on the “Today” show that she had met a woman who said her daughter had “suffered mental retardation from the vaccine.” She went on to say that the HPV vaccine has "very dangerous consequences" and that it puts "little children's lives at risk."<br />The whole off-the-wall discussion during the debate about Perry’s push to promote the HPV vaccine through an executive order had me angry. Bachmann’s fear-mongering about vaccine safety to gain an edge on Perry pushed me over the edge. Within hours, I wrote an <a href="http://www.msnbc.msn.com/id/44507260/ns/health-health_care/t/hpv-vaccine-attack-could-harm-innocent-girls/#.TnYRInPyHsh"><u>impassioned column</u></a> trying to get the facts straight. I posted it on my Facebook page and tweeted it as well. The column got some attention, and I got a number of requests for radio and print interviews about it on Tuesday.<br />On Wednesday I happened to see a Facebook post by my friend and former colleague at the University of Minnesota, Steve Miles. He, too, was angry about Bachmann’s lies about vaccine safety and had posted this item: “I am offering $1,000 for the name and medical records release of the person who Michele Bachmann says became mentally retarded as a consequence of the HPV. Please share this message.”<br />The American Academy of Pediatrics also issued a strong statement, and a few commentators and fact-checking items in the newspapers noted that her remarks were not true. Still, I worried that the stench of fear was going to linger around vaccines yet again, and I decided I should take on Bachmann’s untruths, too. I did not want Bachmann to give more fuel to anti-vaccinators or to risk the lives of children whose parents might not get them vaccinated because of fears she was continuing to stoke.<br />Although I thought Steve’s $1,000 wager would get some attention, I thought we needed to up the ante. We needed a gimmick to debunk the Bachmann blarney. So I tweeted and e-mailed my own challenge: If Bachmann could produce a person within a week who had been made “retarded” by the HPV vaccine, and if that claim could be verified by three doctors that she and I agreed upon, then I would give $10,000 of my own money to a charity of her choice. If not, she would give $10,000 dollars to a charity of my choosing.<br />I repeated the challenge on the radio interviews I had that Thursday morning and said the clock had started ticking. Pretty soon, my phone was ringing and e-mails were coming in from journalists. Steve let me know he did not agree with the terms of my challenge but that he was on board with me and would add his $1,000 dollars to it. So there was an $11,000 throwdown.<br />During interviews that Thursday, I pointed out again and again that there was no evidence at all that the HPV vaccine caused “retardation,” that the CDC/VAERS Web site had never received any such report, that there had been no report I knew of in any other country in the world of any such side-effect despite more than 35 million doses administered, and that it was reprehensible that the same sort of fear-mongering that was causing infants to die of pertussis, flu, rotavirus, measles, and polio around the world was being offered up about HPV vaccine by a serious contender for the presidency of the United States.<br />I then received a request for an interview on <a href="http://www.cnn.com/video/#/video/politics/2011/09/15/ac-caplan-10k-challenge-bachmann.cnn?"><u>“Anderson Cooper 360”</u></a> on CNN about my challenge. The power of TV in American culture is still impressive. After the Anderson Cooper interview, the issue of Bachmann’s vaccine fear-mongering became national news, splashed all over the print, radio, and Internet. Bachmann was being held accountable, and lying about vaccine safety was costing her. By Saturday she had dropped in the polls.<br />Her campaign has not responded to Steve or me. An NPR reporter told me that her press person said she would not respond because she had not received “a letter” from me challenging her views about the HPV vaccine. That response is absurd on its face.<br /><h3>On taking a public stand<br /></h3>Part of the reason I was angry about Bachmann’s comments is that I have been working on vaccine ethics long enough to be acutely aware of the harm caused by vaccine misinformation. In 2004, I had been asked by a Pennsylvania official for help in determining how best to allocate the then-scarce supply of flu vaccine. I told him I did not know anything about vaccines, but that I was sure some bioethicists were working in this area. It turned out that I could not find any to recommend.<br />I began wondering why that was, since vaccines are the single most effective medical intervention ever mounted against disease, with at least one major scourge of humanity, smallpox, eliminated due to vaccines and another, polio (which I had as a child), close to eradication. Long story short, I ended up launching a <a href="http://www.centerforvaccineethicsandpolicy.org/"><u>project at Penn on vaccine ethics</u></a> and a <a href="http://www.vaccineethics.org/"><u>related project</u></a>, which I run with the able help of Jason Schwartz.&nbsp; I signed up for a course on how to make vaccines; sat in on lectures on vaccine issues; and met <a href="http://www.paul-offit.com/"><u>Paul Offit</u></a>, of our Children’s Hospital and department of pediatrics, who had been waging a one-man war against anti-vaccination propaganda for years. I got deeply involved in the subject and wound up publishing quite a bit on vaccines in general and on HPV vaccine in particular.<br />Having been involved in a highly visible way in other situations where politicians, zealots, or advocates have tried to advance misinformation in the name of a political or medical goal – including the Terri Schiavo case, the battle over federal funding of <a href="http://scienceprogress.org/2011/04/the-stem-cell-hype-machine/"><u>embryonic stem cell research</u></a>, the claim that a Belgian man had “<a href="http://www.msnbc.msn.com/id/34132340/ns/health-health_care/t/coherent-after-coma-not-so-sure/#.TnZmgHPyHsg"><u>woken up from a 23-year coma</u></a>” to use facilitated communication to reveal the horror of his experience, and <a href="http://www.msnbc.msn.com/id/43760409/ns/health-health_care/t/stem-cell-clinics-ripping-patients-bullying-scientists"><u>crackpot offers of cures</u></a> with untested adult stem cell therapies, among others – I knew a few things about the importance of speaking up, the need to have scholarship in place to back up one’s comments, and the price that often has to be paid for doing so.<br />The need to speak from an ethical perspective in public forums and outlets about inaccurate, misleading, or outright false claims about bioethical issues should be self-evident. While it is important to publish one’s views in the peer-reviewed literature and to share them in the seminar room, it is equally important for those who have the skills and the facility to communicate with broader audiences to do so. Like economics, political science, climate science, agriculture, and engineering, bioethics is not a purely theoretical field. To do what nearly all of those in the field claim it seeks to do – advance patient interests, enhance the prospect for justice for the least well-off, correct abuses of patient and subject rights – some in the field must engage in policy and public dialogue. At the same time, of course, if one is going to speak up, then it is important either to have published on the matter or to have mastered the relevant subject area at least to the point where one is comfortable teaching and lecturing about it.<br />The danger in advancing civic debate and public understanding is that your own peers will not know your scholarly work on a topic and will see any highly visible public activity as self-promotional pandering – or at best as popularizing, although that is little better on the academic scale of value. The duty to get involved surely overwhelms the price.<br />It is also true that entering the public arena means interaction with the media. Time and again, I have seen my comments distorted, misstated, or simply misused, even by highly respected journalists. It has already happened in the HPV vaccine story. The Internet only makes matters worse, given its immense power of repetition.<br />I think my decision to call out Michelle Bachmann on her comments about vaccine safety and vaccine mandates with my $10,000 challenge was the right one. I believe it is having the effect I intended. The lack of evidence behind nearly all of the claims of vaccine dangers and risks remains in the news. There may even be a better understanding of what is involved in creating different types of vaccine mandates. And women and men in America may be more willing to get their children vaccinated against a disease that kills and maims thousands and to support efforts to get the HPV vaccine to poor women worldwide to prevent many of the hundreds of thousands of deaths that occur every year from cervical cancer.<br />If vaccination is going to be a key part of the winnowing process of those who want to be president, then the framing of that debate has been reset in a much more positive mode.<br /><i>Arthur Caplan is the Emanuel &amp; Robert Hart Director of the Center for Bioethics and Sidney D. Caplan Professor of Medical Ethics at the University of Pennsylvania, and a Hastings Center Fellow. Follow him on Twitter <a href="http://twitter.com/#%21/ArthurCaplan"><u>@ArthurCaplan</u></a>.</i><br />Caplan’s references and writings on vaccines:<br />Boom and bust-have we learned what we need to from the flu vaccine shortage?” <i>Johns Hopkins Advanced Studies in Medicine</i>, 2005: 522-3.<br />“Off the grid: Vaccinations among home-schooled children,” <i>The Journal of Law, Medicine &amp; Ethics</i>, 35, 3, 2007: 471-77. (with D Khalili).<br />“Lessons from the failure of human papillomavirus vaccine state requirements”, <u>Clinical </u><i>Pharmacology and Therapeutics</i>, 82, December, 2007: 760-3, (with JL Schwartz, RR Faden and J Sugarman).<br />“Leveraging Genetic Resources or Moral Blackmail? – Indonesia and Avian Flu Virus Sample Sharing,” <i>American Journal of Bioethics</i>, 7, 11, 2007: 1-2 (with DR Curry).<br />“Ethics” in: S. Plotkin, W. Orenstein and P. Offit, eds., <i>Vaccines</i>, 5<sup>th</sup> ed., 2008: 1677-1684 (with JL Schwartz).<br />“Genital warts: mountains or molehills?” <i>The Lancet Infectious Diseases</i>, 8, 5, 2008; 277-8 (with SC Hull).<br />“A proposed ethical framework for vaccine mandates: Competing values and the case of HPV”, <i>Kennedy Institute of Ethics Journal</i>, 18,2, 2008: 111-124. (with RI Field).<br />“Is Disease eradication unethical?” <i>The Lancet</i>, 373, 2009: 2192-3.<br />“Disease eradication – &nbsp;a response,” <i>The Lancet</i>, 374, 2009: 1144 (letter).<br />“The case for vaccinating boys against HPV,” <i>Public Health Genomics</i>, 12, 2009:362-7 (with S Hull).<br />“Unlicensed Pandemic a (H1N1) Vaccines: Explicit ethical rules of the road are needed in public health emergencies,” <i>The Lancet</i>, 2009: 375, 2010 444-45.<br />“Physician attitudes toward influenza immunization and vaccine mandates,” <i>Vaccine</i>, 28, 2010: 2517-22 (with J Desante and A Behrman, F Shofer).<br />“Influenza vaccination of healthcare personnel,” <i>Infection Control and Hospital Epidemiology</i>, 31, 2010: 987-995<u> </u>(with TR Talbot, H. Babcock, D Cotton, LL Maragakis, GA Poland, DJ Weber).<br />“Clinical trials of drugs and vaccines in poor nations -- ethical challenges and ethical solutions,” <i>Clinical Pharmacology and Therapeutics</i>, 88, 5, 2010: 583-4.<br />“Health care worker support of an influenza vaccine mandate at a large pediatric tertiary care hospital” <i>Vaccine</i>, 29, 9, 2011: 1762-9 (with K Feemster, S Coffin, P Offit, C Feudtner and M. Smith).<br />“Vaccination: facts alone do not policy make,” <i>Health Affairs</i>, 30, June 2011: 1205-8.<br />“Ethics of vaccination programs,” <i>Current Opinion in Virology</i>, 1, 2011: 1-5. (with Jason Schwartz).<br />“Time to mandate influenza vaccination in healthcare workers,” <i>The Lancet</i>, 378, 2011: 310-311.<br />“Vaccination refusal: ethics, individual rights and the common good,” <i>Primary Care Clinics Office Practice</i>, 2011, in press. (with Jason L Schwartz)</div>Posted by Susan Gilbert at 09/20/2011 11:36:03 AM&nbsp;|<br /><div style="background-color: transparent; border: medium none; color: black; overflow: hidden; text-align: left; text-decoration: none;"><br />Read more: <a href="http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5543&amp;blogid=140#ixzz1Ybe5ZQlv" style="color: #003399;">http://www.thehastingscenter.org/Bioethicsforum/Post.aspx?id=5543&amp;blogid=140#ixzz1Ybe5ZQlv</a></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-59412357959470324992011-09-19T10:57:00.001-07:002011-09-19T10:57:55.432-07:00Too Many Tasks (Marin IJ)<style><!-- /* Font Definitions */ @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:Cambria; mso-bidi-font-family:"Times New Roman";} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br /><div class="MsoNormal">I’m sitting down to write on an important topic. <i>I should check my email</i>. Right, where was I? An important topic for students, parents, professionals, and, well, just about everyone. <i>Who’s texting me? Oh shoot; I need to finish that Amazon order. I forgot to call the plumber. And the dog needs to go out. Did I feed my daughter’s Brazilian water frog?</i><span style="mso-bidi-font-style: italic;"> <i>I should check my email. </i></span>Wait, focus. Important topic. Interesting topic. And it’s critical that everyone understand the limitations and risks associated with it. <i>I really should check my email. </i>Multi...<i>must check email! …</i>Tasking. </div><div class="MsoNormal">Like many people in our digitalized and sensory-loaded world, I’m a fervent multi-tasker. Email, bills, scheduling, patient-care, child-care, pet-care, Twitter-care, fantasy sports; I can do it all. And I can do it all at the same time! At least so I thought. <i>Just checked my email for the fourth time this paragraph. My wife wants to know if we can go to a school fundraiser tonight. My boss is trying to schedule a tennis match. I wonder which QBs are available on the cbsportsline waiver wire? Expedia has a new fare alert for me. $299 bucks to fly to Omaha! Sweet. </i>Contrary to the ethos I’ve prided myself on, in a world of information overload, constant data processing can actually “smog,” “asphyxiate,” and starve away productive time. In fact, multi-tasking may threaten efficiency more than aid it.<span style="mso-spacerun: yes;">&nbsp; </span></div><div class="MsoNormal">Skeptical? Well, stay with me here (your stock portfolio and Facebook newsfeed can wait), and consider evidence from cognitive testing. Researchers looking at individuals performing two or more tasks at once have found that, quite consistently, people complete tasks faster if they do them serially (one, then the other) rather than in parallel (start one, start the other, back to the first, and so on). In fact, loss of efficiency has been estimated to be around half-a-second per task switch and up to twice the sum of the time needed to complete two tasks in order. So, for example, if it takes me two minutes to check and respond to my email and three minutes to order a new mattress online, it would take me up to ten minutes to do the two tasks “at the same time” (switching back and forth between tasks with a delay with each switch). But if I did the tasks serially (i.e. focusing on one task and completing it before moving on to the next), the two tasks should take me only five minutes. </div><div class="MsoNormal">Now, as we all know, multi-tasking is more or less a fact of life. Most of us are forced to multi-task some or all of the time, both at work and at home. A busy shift in the Emergency Department (ED) is an excellent example of this, and one that I’m quite familiar with. I spend my days talking with patients, performing physical exams, entering orders, documenting, calling consultants, communicating with nursing and other personnel, performing procedures, making referrals, all while trying not to neglect an important task like prescribing the correct medication. Studies of ED physicians demonstrate that their tasks will be interrupted four to fourteen times per hour, or every four minutes or so. An observational study of nurses reported that ED nurses (at work) multitask 34% of the time. Each and every single one of the interruptions that ED providers experience could have disastrous consequences. (This is why we have developed safety mechanisms like timeouts and checklists.) </div><div class="MsoNormal">But of course, some multi-tasking is unavoidable. Our patients surely appreciate that we break away from a routine task, like charting, to tackle another more critical task, such as providing acute resuscitation. And, keep in mind that some “multitasking” is not harmful. For some people, listening to music while driving or studying is not really multi-tasking at all but rather a multi-sensory approach to a task. This habit may or may not affect efficiency and performance. People are (according to cognitive studies) able to train themselves to block out distractions when performing an assignment. Note that I say “distractions” and not tasks. Tasks, especially ones that require working memory - very short term memory designed to aid in completion of short term tasks - will be more efficiently completed in order and cannot be blocked out as part of a multisensory approach. Working memory is ephemeral and highly sensitive to interruptions. We all experience this as those “I lost my train of thought” moments. </div><div class="MsoNormal">Can you minimize brain stalls and achieve a healthy level of multi-tasking? Maybe, but first you have to set aside dedicated time to think, focus, and plan. Creativity benefits from focus and people who have planned or rehearsed tasks beforehand are less likely to suffer delays. Here’s another tip: try to resist over-dosing on jolts of satisfaction (“dopamine squirts”) associated with compulsive behavior – like checking email every 2.4 minutes. And when possible, finish what you started<span style="mso-spacerun: yes;">&nbsp; </span>- NOW – rather than deferring it to the “later” bucket. Working memory is temporary and what may seem unforgettable right now is actually quite forgettable in 15 minutes. Finally, experiment with focus adjuncts – meditation or paying attention to your breathing may help, as might noise-erasing headphones (which, my wife lovingly has dubbed “wife- and kid-erasers”). Of course, a lot of the modern world cannot be easily “noise-erased,” but if you make an effort to slow down, especially with important endeavors, your reward, ultimately, will be higher efficiency and fewer mistakes. </div><div class="MsoNormal">Well, phew, I’ve made it through this task. Hope you did too. <i style="mso-bidi-font-style: normal;">How many unread emails do I </i>have? <i style="mso-bidi-font-style: normal;">That frog must be absolutely starving.</i> Now, if you’ll excuse me, I’ve got a few other things to do…</div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-88397801907363098022011-09-19T10:56:00.001-07:002011-09-19T10:56:56.426-07:00Work Does Not Have to Hurt (Marin IJ)<style><!-- /* Font Definitions */ @font-face {font-family:Times; panose-1:2 0 5 0 0 0 0 0 0 0; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin-top:0in; margin-right:0in; margin-bottom:10.0pt; margin-left:0in; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-fareast-font-family:Cambria; mso-fareast-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} --></style> <br /><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-size: 10.0pt; mso-font-kerning: 18.0pt;">This Labor Day, as we honor workers, let us also celebrate workplace safety. Well, perhaps workplace safety is not so much something we celebrate, as it is something we should expect. And if you consider where we’ve come from, remarkable progress has truly been made. Over one hundred years ago, Upton Sinclair’s novel <i style="mso-bidi-font-style: normal;">The Jungle</i> depicted the truly awful working conditions of the early 20<sup>th</sup> century Chicago meatpacking industry. For example, consider the job of </span>“beef-boner”…”Your hands are slippery, and your knife is slippery, and you are toiling like mad, when somebody happens to speak to you, or you strike a bone. Then your hand slips up on the blade, and there is a fearful gash. And that would not be so bad, only for the deadly contagion. The cut may heal, but you never can tell.” Grimy and grim. And workplace danger was not restricted to beef boners – in year <span style="font-family: Times; mso-bidi-font-size: 10.0pt; mso-font-kerning: 18.0pt;">1913 alone, </span>the Bureau of Labor Statistics (BLS) documented 23,000 industrial deaths among a workforce of 38 million, equivalent to a rate of 61 deaths per 100,000 workers. And there were likely thousands more that went un-documented. Even thirty years ago, in the 1980s, after vast improvements in working conditions and safety, over 7000 people a year died on the job. </div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">Last week, the BLS released the data for 2010, reporting 4,547 fatal work injuries, a rate nearly twenty fold improved from 1913. Of the year 2010 deaths, 1,766 were transportation related, 808 from assaults (including self-inflicted), 732 from being struck by an object, 635 from falls, 409 from toxic exposures and 187 from fires and explosions. Occupation-wise, the greatest magnitude of deaths was seen in transportation/material moving (1,115) and construction/mining industries (760). A somewhat surprising third were management occupations (533) – including 29 (no longer) top executives. </div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">So nowadays, as you can see, workplace deaths are rare enough that they are fastidiously tracked – in fact you can find a description of specific events on the OSHA website (this, by the way, is only recommended for <i style="mso-bidi-font-style: normal;">Faces of Death </i>aficionados). Cleary, further improvements in work safety are possible but nonetheless, non-fatal injuries on the job are a problem of much greater frequency. According to 2009 BLS data, there were over 3.2 million workplace injuries or illness reported in the private sector alone. These include 195,150 back injuries and 212,760 falls. Ouch. In all, days-away-from-work approached one million in 2009 (this was actually an 11% decrease from 2008). As one might expect, high risk professions include those with significant lifting/physicality requirements – such as <span style="mso-bidi-font-family: Courier; mso-bidi-font-size: 10.0pt;">patrol officers, nursing aides, orderlies and attendants, delivery truck drivers, construction laborers, and janitors and cleaners.</span><span style="font-family: Courier; font-size: 10.0pt; mso-bidi-font-family: Courier;"> </span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">No profession, however, is immune from on the job injuries. Even pillow softness testers must suffer some risk– although it is not immediately evident to me what this might be. Hazards exist in the offices and hallways around us. To help keep you safe in these environments, I canvassed the web (www.workplacesafetytips.org/) and Dr. Scott Levy, Chief of Occupational Medicine at San Rafael Kaiser, for some safety tips. </div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-size: 10.0pt; mso-font-kerning: 18.0pt;">1) </span><b style="mso-bidi-font-weight: normal;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Boot the boxes…</span></b><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;"><br />And other clutter out of the hallway and walkways. Tripping over your own box of files would not only be embarrassing, it could also be quite painful. </span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">2) <b style="mso-bidi-font-weight: normal;">Don’t carry anything higher than your eye level or read while walking.</b><br />Can’t see where you are going? Carrying a heavy load? Not noticing Wobbly Wanda and her cup of very hot tea. Ruh-oh.</span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">3) <b style="mso-bidi-font-weight: normal;">Don’t run unless someone’s life is at stake. </b></span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">Stieg Larsson, author of <i style="mso-bidi-font-style: normal;">The Girl with the Dragon Tattoo</i>, died prematurely because the elevator was broken and he ran seven flights of steps to make a meeting on time. His heart couldn’t take the stress of always being in a rush. Can yours?</span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-outline-level: 1; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">4) <b style="mso-bidi-font-weight: normal;">Look before you sit.</b><br />Seems simple, but a chair is not always that clear of a target to hit – especially if you’re distracted. A bruised bum or a bum back could be your penance for poor sitting technique.</span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">5) <b style="mso-bidi-font-weight: normal;">Think Ergonomically</b></span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">A properly designed (ergonomic) workstation can help minimize work place injuries. This fact becomes quite obvious when people with very different proportions attempt to use the same workspace.</div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">6) <b style="mso-bidi-font-weight: normal;">Something’s in the air around here</b></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">Besides hazards that lead to musculoskeletal injuries, consider other sources of injury. Strong scented colognes and perfumes can easily aggravate allergies and trigger asthma attacks.</div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">7) <b style="mso-bidi-font-weight: normal;">Wellness is not for Wussies.</b></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">Consider starting or joining a workplace wellness program. &nbsp;There's a lot of evidence that having a healthier workforce will lead to fewer injuries.</div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">8) <b style="mso-bidi-font-weight: normal;">Light Matters</b></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">Don't overlook the importance and relevance of your office lighting. Traditional fluorescent light bulbs flicker very rapidly and can lead to increased fatigue – not to mention irritability. <span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;"></span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">9<b style="mso-bidi-font-weight: normal;">) Control the Urge to Multi-Task</b></span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">This is a tough one – and I’m as guilty as the next over-stimulated employee. More on this another time, but just know that serious multi-tasking does not help you to be more effective, in fact it can be quite detrimental. You are much more likely to forget something important (such as driving on the right side of the road) if your mind is flipping back and forth between two activities. </span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;">In sum, advises Dr. Levy…</span>“Although office injuries will never drop to zero despite our best efforts, there are ways to minimize the numbers. &nbsp;Developing an ongoing program where office hazards are continually monitored will lead to improved staff morale in addition to the obvious benefit of an overall safer workplace.”<span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;"></span></div><div class="MsoNormal"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;">Indeed, work does not have to hurt. <span style="font-family: Times; mso-bidi-font-family: &quot;Times New Roman&quot;; mso-bidi-font-size: 10.0pt;"></span></div><div class="MsoNormal"><br /></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-77989352033582072652011-08-24T09:34:00.001-07:002011-09-29T11:33:12.919-07:00A Back to School Basic<style><!-- /* Font Definitions */ @font-face {font-family:Arial; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:"Courier New"; 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margin:1.0in 1.25in 1.0in 1.25in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:918368694; mso-list-type:hybrid; mso-list-template-ids:-1588679524 67698693 67698691 67698693 67698689 67698691 67698693 67698689 67698691 67698693;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; font-family:Wingdings;} @list l0:level2 {mso-level-number-format:bullet; mso-level-text:o; mso-level-tab-stop:1.0in; mso-level-number-position:left; text-indent:-.25in; font-family:"Courier New";} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --></style> <br /><div class="MsoNormal"><br /></div><div class="MsoNormal">The phrase “Back to school,” can elicit a wide range of thoughts. Emotional responses include excitement, nerves, and in the case of my wife a profound “Thank Goodness!” My daughter, about to enter first grade, has a somewhat different opinion. “Can my American Girl go instead?”. No matter what, this is the time of year of making back to school plans and lists. Pencils, erasers, coloring books and computer accessories. Notebooks, crayons, backpacks and brown bag lunches. Scissors, sanitizer and glue sticks. Gym clothes, clean underwear and shoes that fit. Feel like something important is missing? Well if you are a 7<sup>th</sup>-12<sup>th</sup> grader without an up to date pertussis (whooping cought) booster, than yes, something important is missing. In fact, this something is critically important – as you may not be allowed to attend school without it. </div><div class="MsoNormal">Last year, the state legislature passed AB354, which mandates an up to date pertussis booster (as part of the Tdap immunization) for all 7<sup>th</sup>-12<sup>th</sup> students. Based on this new law and immunization records, an estimated 5,000 students in Marin will need to move the Tdap shot to the top of their back to school list, or else there may just not be a school to go back to. Now, if you or your children are in this group, this requirement likely seems like a hassle, and it is. But, there is a good reason. I’ll take a moment to explain... </div><div class="MsoNormal"><br /></div><div class="MsoNormal">Vaccination efforts during the past century have made certain childhood diseases so rare that they seem like remnants of an uncivilized past. Few of us have actually seen a new case of polio or measles, so it’s easy to be lulled into thinking that these ailments are so antiquated they couldn’t possibly cause trouble again. Unfortunately, this is just not true. The diseases that we vaccinate against are not extinct; they are lurking, waiting for enough people to drop their guard. If you think that I am an alarmist, consider these recent outbreaks: polio in Nigeria, measles across the U.S. and whooping cough in Marin County. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">We are currently in the midst largest pertussis outbreak in 40 years – with ten deaths in California alone. Nationwide, measles is back – with a confirmed 156 cases in the first half of this year – the most since 1996. These outbreaks should remind us that we aren’t as safe from vaccine preventable diseases as we may think. Pertussis, for instance, is a highly contagious lung infection that can affect both children and adults and classically causes a “whoop” after coughing. In the days before DTP (diptheria-tetanus-pertussis) immunization, pertussis killed thousands of infants every year – often because the cough was so severe that it caused them to start bleeding in the brain. Thankfully, with the advent of widespread vaccination, the number of infections declined 99% between the 1930s and the 1980s and the death rate plummeted to single digits by the 1990s. In the last ten years, however, we’ve seen a resurgence of this infant-killer. Nationwide in 2005, there were over 25,000 cases of pertussis reported to the CDC; 21 of these were in Marin County. There are several explanations for pertussis’ comeback, but mostly it can be blamed on under-immunization. The protection afforded by the pertussis vaccine tends to wear off three to five years after vaccination, thus even children who have received the recommended DTaP series (five shots between the ages of 2 months and 6 years) are at risk for contracting the disease later.&nbsp; Because of herd immunity (immunity that occurs when the <a href="http://en.wikipedia.org/wiki/Vaccination" title="Vaccination"><span style="color: windowtext; text-decoration: none;">vaccination</span></a> of part of the community – or herd – provides protection to unvaccinated individuals) many parents think that their children are protected against pertussis (and other diseases) even if they are not fully vaccinated. Unfortunately, the more parents who believe this and exercise the (personal belief) exemption to mandatory vaccination, the more likely it is that herd immunity will fail. This is why a group of pediatricians in Philadelphia have published a manifesto to those who “absolutely” refuse to immunize: “by not vaccinating your child you are taking selfish advantage of thousands of others who do vaccinate their children ... We feel such an attitude to be self-centered and unacceptable.” These pediatricians would be appalled with vaccination rates in Marin – according to <span style="color: black;">the California Department of Public Health, the Marin County kindergarten immunization rate is 84.7%, significantly below the state rate of 92.1%. </span>And while we have long suspected that un-immunized children are at greater risk of disease, we now have solid evidence of this. Two papers published in 2009 by a team of researchers from Colorado document significantly increased risk of pertussis (twenty-three fold risk) and varicella (nine-fold) in children whose parents refuse these immunizations. </div><div class="MsoNormal"><br /></div><div class="MsoNormal">So, what can we do to ward off a further surge in preventable infectious disease? Well, a great place to start is at the top of that back to school list. Fortunately, efforts are in play to make this as hassle free as possible. The Marin County Department of Health and Human Services is partnering with the Marin County Office of Education, San Rafael Kaiser Permanente, the Marin County School Nurses’ Association and the Marin Medical Reserve Corps to offer five vaccine clinics in school sites around the county just before the start of classes. At these clinics the vaccine will be offered at no cost to Kaiser members and the many students who qualify for free vaccine under federal rules and at a maximum will cost $32. Dates are August 15<sup>th</sup>, 16<sup>th</sup>, 17<sup>th</sup>, 19<sup>th</sup> and 22<sup>nd</sup>. For more information and details visit <b style="mso-bidi-font-weight: normal;"><span style="font-family: Arial;"><a href="http://www.co.marin.ca.us/tdap">http://www.co.marin.ca.us/tdap</a>. </span></b></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-18360680702473490042011-08-24T09:32:00.000-07:002011-08-24T09:32:21.638-07:00Meditations on Placebo (Marin IJ)<br /><style>
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</style> <br /><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">I’ve had placebo on the mind recently. This preoccupation started at the gym after a discussion with a self-described “Zennie,” who tried to convince me of the benefits of meditation - particularly for priming athletes for peak performance. This woman, herself a practitioner of “muga-mushin,” (Japanese for “no mind, no self”), asserted that an athlete could benefit more from careful visualization than from actual practice. I was skeptical; I have to believe Kobe Bryant’s jumper is better served by physical practice than mental repetition. And this is when I started thinking about the placebo effect - the well-described sugar pill phenomenon in which patients experience significant improvement from sham treatments. It occurred to me that perhaps the mind-body benefits seen with placebos were not all that different than those achieved via meditation. And, I began to wonder, could meditation be used to consciously invoke the placebo effect? </span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">Medical literature has, over and over again, demonstrated the power of placebo. Last year, for instance, a <i style="mso-bidi-font-style: normal;">Newsweek</i> cover story examined remarkable placebo treatments for depression – so remarkable that they are making it difficult for drug makers to prove the advantages of new anti-depressant medications. (The placebo response has become so robust in clinical trials that the drugs cannot outperform it.) Similarly, a recent Harvard study of asthmatics found 45% improvement in symptoms with a fake inhaler and 46% improvement with impostor acupuncture – compared to 50% with an actual treatment (albuterol).<span style="mso-spacerun: yes;">&nbsp; </span>Beyond just "tricking the brain to feel better," placebo treatments seem capable of causing actual neurological and physiological (bodily response) changes. </span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">Even more startling was a recent study of patients with irritable bowel syndrome (IBS – a chronic gut condition characterized by pain and bowel irregularities). This study utilized an “open-label” placebo – in other words a placebo treatment without deception. In the investigation, led by Ted J. Kaptchuk and colleagues and published in December of 2010, eighty IBS patients were given either 1] no additional therapy or 2] treatment with what they described to the patients as “placebo pills made of an inert substance, like sugar pills, that have been shown in clinical studies to produce significant improvement in IBS symptoms through mind-body self-healing processes." Self-reported symptom scores were assessed at 0, 11 and 21 days after the initiation of treatment. The results demonstrated significant improvements in symptom severity and relief in the placebo group. </span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">Now, this study was a small one, with possible confounders (such as unreliability in patient symptom reporting) but certainly is provocative and promising. For years, physicians have struggled with placebo treatments – because they assumed that trickery was necessary for them to work. Trickery puts doctors in an uncomfortable position – having to choose between two ethical principles – beneficence (helping the patient) and autonomy (helping them make informed decisions). To freely prescribe placebo without the troublesome concealment component opens up a clear pathway for placebo treatments for many conditions - depression, asthma, chronic pain, IBS, addiction, hypertension, and more.<span style="mso-spacerun: yes;">&nbsp; </span>Now, I should be clear, there are limits to the physiologic possibilities for placebo. We can’t expect mind-over-matter to work with a bleeding limb or widely metastatic cancer.</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">Nonetheless, the ramifications of the IBS study, if borne out in subsequent studies, are huge - the placebo effect may not require deception at all. Perhaps it’s been mischaracterized for decades and perhaps conscious attempts at self-healing should</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">be carefully examined and mainstreamed. And this brings me back to meditation. Could meditation function like a placebo treatment for some conditions? I do not see why not. I’m no expert in Buddhism or meditation and I do not meditate (small children in the home would seem to make that nearly impossible). Still, I know there are a lot of different types of medication from a number of religious and spiritual traditions. And for the sake of this topic, I think we can agree</span> that each shares an emphasis on channeling attention and achieving a still, rather than muddied and churning, mind. With that context,<span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;"> here’s some substantiation for meditation. First, and anecdotally, from my gymnasium Zennie… </span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">- She successfully used meditation to limit sweating on a very hot day, reporting that she “</span><span style="color: black;">was able to <i style="mso-bidi-font-style: normal;">not</i> sweat, save for a light sweat film on the face (nothing under the arms or chest.)” This, by the way, is not a recommended approach to dealing with the heat.</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;">-She successfully used meditation to prepare for extreme 24-hour straight sessions on the rowing machine achieving “no pain, total relaxation in the moment and no tension.” This by the way, is not a recommended fitness regimen. </div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">Not sold? Here’s what the medical literature has to say… </span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">-Functional MRI studies by Richard Davidson at University of Wisconsin demonstrate that meditation can have measurable effects on certain regions of the brain (such as in the process of consciously cultivating empathy). </span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">-Other studies suggest that meditation can help young adults cope with stress and can improve information-processing in adults.</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">-Studies of flu vaccine efficacy suggest that meditation can help boost the body’s immune response. </span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><span style="mso-bidi-font-family: Times-Bold; mso-bidi-font-weight: bold;">There is still much research to be done and I suspect that meditation is just one of a number of means of achieving better health through mind-body synching. Exercise, healthy relationships and optimism, for instance, may benefit the body through similar mechanisms. While the methods may vary, the physiologic mechanisms are likely similar. But, more on this another time. For now, I need to get back to the couch for some six-pack abs training - visualizing crunches is so much more comfortable than the real thing!</span></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal" style="margin-bottom: .0001pt; margin-bottom: 0in; mso-layout-grid-align: none; mso-pagination: none; text-autospace: none;"><br /></div><div class="MsoNormal"><br /></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.comtag:blogger.com,1999:blog-2810266452851494301.post-71067442036273948382011-07-28T08:03:00.001-07:002011-07-28T08:03:58.414-07:00Summer Sweating (Marin IJ)<style><!-- /* Font Definitions */ @font-face {font-family:Arial; panose-1:2 11 6 4 2 2 2 2 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:"Courier New"; panose-1:2 7 3 9 2 2 5 2 4 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} @font-face {font-family:Wingdings; panose-1:5 2 1 2 1 8 4 8 7 8; mso-font-charset:2; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:0 0 65536 0 -2147483648 0;} @font-face {font-family:Cambria; panose-1:2 4 5 3 5 4 6 3 2 4; mso-font-charset:0; mso-generic-font-family:auto; mso-font-pitch:variable; mso-font-signature:3 0 0 0 1 0;} /* Style Definitions */ p.MsoNormal, li.MsoNormal, div.MsoNormal {mso-style-parent:""; margin:0in; margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:Cambria; mso-fareast-font-family:Cambria; mso-bidi-font-family:Cambria;} a:link, span.MsoHyperlink {mso-style-noshow:yes; font-family:"Times New Roman"; mso-bidi-font-family:"Times New Roman"; color:blue; text-decoration:underline; text-underline:single;} a:visited, span.MsoHyperlinkFollowed {mso-style-noshow:yes; color:purple; text-decoration:underline; text-underline:single;} @page Section1 {size:8.5in 11.0in; margin:1.0in 1.0in 1.0in 1.0in; mso-header-margin:.5in; mso-footer-margin:.5in; mso-paper-source:0;} div.Section1 {page:Section1;} /* List Definitions */ @list l0 {mso-list-id:1446733221; mso-list-template-ids:1566611600;} @list l0:level1 {mso-level-number-format:bullet; mso-level-text:; mso-level-tab-stop:.5in; mso-level-number-position:left; text-indent:-.25in; mso-ansi-font-size:10.0pt; font-family:Symbol;} ol {margin-bottom:0in;} ul {margin-bottom:0in;} --></style> <br /><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial; mso-bidi-font-family: Arial;">Summer is officially in effect. It’s time for Beer-bques, beach bumming, and picnicking in the rapidly browning grass. There are many things to love about summer, but one thing few of us love is summer sweat. Yes, for many, summer is the season of sweating. </span><span style="font-family: Arial;">Now, we all know that perspiration plays an important bodily function. By coating our bodies with moisture, it promotes evaporative heat loss and keeps us from over-heating and shriveling like slugs in the sun. </span><span style="font-family: Arial; mso-bidi-font-family: Arial;">Still, most folks don’t think that sweating is cool. Sweat stains on t-shirts and salty dribbles down the forehead (not to mention clammy hands and soggy feet) are embarrassing and distracting. Or, perhaps you’re like me and sweat profusely whenever you visit the doctor’s office – in my case to the point of disintegrating the disposable paper sheet on the examining table; an odd response, indeed, for someone who works in the medical field. </span></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><span style="font-family: Arial; mso-bidi-font-family: Arial;">Luckily, I have a sweat expert in the family. My wife Angela is a contributing writer for the International Hyperhidrosis Society (www.sweathelp.org</span><span style="font-family: Arial;">)</span><span style="font-family: Arial; mso-bidi-font-family: Arial;">, the foremost provider of support and informational resources to the world’s community of excessive sweaters (that is people who sweat a lot, not those who excessively wear sweaters). Hyperhidrosis is an actual medical condition characterized by excessive sweating above and beyond what is needed to keep the body cool. Those with hyperhidrosis may sweat four or five times more than normal - regardless of external conditions - and their sweating is so extreme that it interferes with daily life. Now, someone with that level of lather should probably seek professional help, but for the rest of us who just want to curtail the average summer slather, here, adapted from the work of my in-home sweat consultant, are some tips. </span></div><div class="MsoNormal" style="margin-bottom: 12.0pt;"><br /></div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: .1pt; margin-top: .1pt; mso-list: l0 level1 lfo1; mso-para-margin-bottom: .01gd; mso-para-margin-top: .01gd; tab-stops: list .5in;"><span style="font-family: Arial;">First of all, remember that sweat plays a critical role in keeping you cool in hot temperatures. The key to keeping your body’s air conditioning working properly is hydration. Drink early, drink often, and drink again. </span><span style="font-family: Arial; mso-bidi-font-family: Arial;">Limiting fluid intake is most definitely not a healthy approach to sweat suppression. You can help your natural cooling system by using a vaporizer or atomizer to spray a light mist of water under your arms. As the water evaporates your body will naturally cool.</span><span style="font-family: Arial;"></span></li></ul><div class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><br /></div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: .1pt; margin-top: .1pt; mso-list: l0 level1 lfo1; mso-para-margin-bottom: .01gd; mso-para-margin-top: .01gd; tab-stops: list .5in;"><span style="font-family: Arial;">Dress for summer sweat-ccess. Wear loose, lightweight, and light-colored clothing. Choose natural, breathable fabrics, such as cotton, or hi-tech fabrics designed to “wick” moisture away from your skin. </span></li></ul><div class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><br /></div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: .1pt; margin-top: .1pt; mso-list: l0 level1 lfo1; mso-para-margin-bottom: .01gd; mso-para-margin-top: .01gd; tab-stops: list .5in;"><span style="font-family: Arial;">Sun-damaged or burned skin is not as effective at dissipating body heat and can have lasting consequences. Protect your skin and stay cooler by avoiding the peak sun hours. Sunscreen is a hot topic right now, and you should know that there is quite a bit of misleading advertising out there and not all sunscreens are created equal. New FDA regulations have been issued, but companies have at least one year to comply with these sensible new standards. Nonetheless, you should stay sunburn safe if you stick to sunscreens that are 1) SPF 15 to SPF 50, 2) have both UVA and UVB protection and 3) make sure to re-apply frequently. </span></li></ul><div class="MsoNormal"><br /></div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: .1pt; margin-top: .1pt; mso-list: l0 level1 lfo1; mso-para-margin-bottom: .01gd; mso-para-margin-top: .01gd; tab-stops: list .5in;"><span style="font-family: Arial;">If you sweat profusely from your forehead and/or face, consider wearing a wide-brimmed or long-billed hat. As with your clothing, your hat should be lightweight and light-colored. Coolibar hats, among others, have earned a “seal of recommendation” from The Skin Cancer Foundation.</span></li></ul><div class="MsoNormal" style="margin-bottom: 12.0pt;"><br /></div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: .1pt; margin-top: .1pt; mso-list: l0 level1 lfo1; mso-para-margin-bottom: .01gd; mso-para-margin-top: .01gd; tab-stops: list .5in;"><span style="font-family: Arial;">When it’s hot outside and especially during summer exercise sessions, temperatures inside shoes and socks can reach 120 degrees Fahrenheit. Choose lightweight, breathable or ventilated shoes or sandals and use sweat absorbing inserts (such as Summer Soles). When wearing socks, choose pairs that wick moisture away from your feet such as those designed for athletes and hikers. Absorbent foot powders and antiperspirants can also be used on feet to minimize sweating and moisture buildup.</span></li></ul><div class="MsoNormal" style="margin-bottom: 12.0pt; margin-left: .5in; margin-right: 0in; margin-top: 0in;"><br /></div><ul style="margin-top: 0in;" type="disc"><li class="MsoNormal" style="margin-bottom: .1pt; margin-top: .1pt; mso-list: l0 level1 lfo1; mso-para-margin-bottom: .01gd; mso-para-margin-top: .01gd; tab-stops: list .5in;"><span style="font-family: Arial;">Bust armpit wet marks by changing your antiperspirant routine. Choose a soft-solid formula and apply antiperspirant to underarms once in the morning and again prior to bedtime. Application twice daily—and especially before bedtime—has been shown to be more effective. Gently massaging the antiperspirant into the skin may be useful. You can consider using a stronger over-the-counter antiperspirant such as Certain Dri or Secret Clinical Strength (active ingredients; aluminum chloride and</span> <span style="font-family: Arial;">aluminum zirconium trichlorohydrex). To avoid irritation, only apply antiperspirant to completely dry skin. If you suffer from an annoyingly sweaty face, consider applying an antiperspirant along your hairline. Follow the application tips mentioned above, but test the product on a tiny area of skin first to make sure that it won’t cause irritation.</span></li></ul><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal"><span style="font-family: Arial; mso-bidi-font-family: Arial;">Wow, thanks honey, that’s a lot of good perspiration inspiration. Before we wick away this topic, however, I should note that there are quite a few serious medical conditions that are associated with sweating. These include, and are not limited to – infection, heart disease, adverse medication effects or overdose, thyroid or endocrine disease, and certain types of tumors. New patterns of sweat, or sweat associated with other concerning symptoms (like the feeling of a rhino stomping on your chest) should trigger you to seek medical evaluation.</span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><span style="font-family: Arial; mso-bidi-font-family: Arial;">And finally, to reiterate, if</span><span style="font-family: Arial;"> you think you suffer from excessive sweating (hyperhidrosis) or your sweat is not adequately controlled by over the counter products, you should talk to a dermatologist about other treatment options. These include: prescription </span><a href="http://www.sweathelp.org/English/PFF_Treatment_Antiperspirants.asp"><span style="color: windowtext; font-family: Arial; text-decoration: none; text-underline: none;">antiperspirants</span></a><span style="font-family: Arial;">, </span><a href="http://www.sweathelp.org/English/PFF_Treatment_Iontophoresis.asp"><span style="color: windowtext; font-family: Arial; text-decoration: none; text-underline: none;">iontophoresis</span></a><span style="font-family: Arial;"> (machines like Fisher Galvanic and Drionic) and </span><a href="http://www.sweathelp.org/English/PFF_Treatment_Injections.asp"><span style="color: windowtext; font-family: Arial; text-decoration: none; text-underline: none;">Botox injections</span></a><span style="font-family: Arial;">. Dr. John Maddox, chief of dermatology at San Rafael Kaiser, told me that the time to seek help for sweating is when it “becomes such an everyday problem that it affects life and work – such as not being able to type because one’s hands slip off the keyboard.” I suppose, for me that means I shouldn’t ever pursue a career as a professional patient. As for those of us who find themselves sweating more in the summer... “Regular sweat in the summer time?” says Dr. Maddox, “Don’t sweat it!”</span></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal" style="margin-bottom: .1pt; margin-left: 0in; margin-right: 0in; margin-top: .1pt; mso-para-margin-bottom: .01gd; mso-para-margin-left: 0in; mso-para-margin-right: 0in; mso-para-margin-top: .01gd;"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div><div class="MsoNormal"><br /></div>DWBhttp://www.blogger.com/profile/14177368021970752021noreply@blogger.com